Individual
MERRIE VISCARRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1530 N RANDALL RD STE 210, ELGIN, IL 60123-7879
(224) 760-7322
(224) 535-8252
Mailing address
6400 INDUSTRIAL LOOP, GREENDALE, WI 53129-2452
(414) 858-4106
(414) 423-4134
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
036113267
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036113267
—
IL
01
—
1633786
BCBS PROVIDER ID
IL
01
—
P00255743
RAILROAD MEDICARE
IL
Enumeration date
09/23/2005
Last updated
10/09/2018
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