Provider Demographics
NPI:1184680654
Name:MERRICK, DANIEL SETH (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:SETH
Last Name:MERRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 N CALIFORNIA AVE
Mailing Address - Street 2:STE F803
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-7014
Mailing Address - Country:US
Mailing Address - Phone:773-878-7555
Mailing Address - Fax:773-878-8545
Practice Address - Street 1:5215 N CALIFORNIA AVE
Practice Address - Street 2:STE F803
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-7014
Practice Address - Country:US
Practice Address - Phone:773-878-7555
Practice Address - Fax:773-878-8545
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36088033208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036088033Medicaid
IL036088033Medicaid
5514060010Medicare NSC
F77602Medicare UPIN
214706022Medicare PIN