Provider Demographics
NPI:1164112199
Name:MERRILL, ROGER LEO III
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:LEO
Last Name:MERRILL
Suffix:III
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:TRACE
Other - Middle Name:
Other - Last Name:MERRILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3786 DELANO DR
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-9677
Mailing Address - Country:US
Mailing Address - Phone:517-282-4001
Mailing Address - Fax:
Practice Address - Street 1:3786 DELANO DR
Practice Address - Street 2:
Practice Address - City:EATON RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:48827-9677
Practice Address - Country:US
Practice Address - Phone:517-282-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care