Provider Demographics
NPI:1376506915
Name:MERKLE, GEORGE W (MD PC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:W
Last Name:MERKLE
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 N MAIN
Mailing Address - Street 2:STE A
Mailing Address - City:BUFFTON
Mailing Address - State:IN
Mailing Address - Zip Code:46714
Mailing Address - Country:US
Mailing Address - Phone:260-824-4315
Mailing Address - Fax:260-824-4962
Practice Address - Street 1:360 N MAIN ST
Practice Address - Street 2:STE A
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-2041
Practice Address - Country:US
Practice Address - Phone:260-824-4315
Practice Address - Fax:260-824-4962
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023363207Q00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000179540OtherANTHEM
IN100257790Medicaid
E05878Medicare UPIN
IN186800AMedicare PIN