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Individual
PETER T MERRELL
Active
Individual
PETER T MERRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002160
IA
363A00000X
Physician Assistant
085003115
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209395029
MEDICARE PTAN
IL
01
—
578210026
MEDICARE PTAN
IA
Enumeration date
10/23/2007
Last updated
03/05/2026
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