Individual
DR. ROBERT E. MERRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1633 W BERWYN AVE, CHICAGO, IL 60640-2005
(217) 848-7856
Mailing address
1633 W BERWYN AVE, CHICAGO, IL 60640-2005
(217) 848-7856
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
036054685
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00115241
BLUE SHIELD
IL
05
—
036054685
—
IL
01
—
110123
BLUE SHIELD
IL
Enumeration date
04/06/2007
Last updated
02/24/2020
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