Individual
DR. MERRIT MARION DEBARTOLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2000 LAKE AVE, WOODSTOCK, IL 60098-7401
(815) 337-7100
(815) 337-4793
Mailing address
2000 LAKE AVE, WOODSTOCK, IL 60098-7401
(815) 337-7100
(815) 337-4793
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
036-140512
IL
208800000X
Urology Physician
65614
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427379189
—
WI
Enumeration date
06/17/2010
Last updated
03/17/2018
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