Provider Demographics
NPI:1417919499
Name:KROLICK, MERRILL A (DO)
Entity Type:Individual
Prefix:DR
First Name:MERRILL
Middle Name:A
Last Name:KROLICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1345 W BAY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2282
Mailing Address - Country:US
Mailing Address - Phone:727-581-3550
Mailing Address - Fax:727-586-6190
Practice Address - Street 1:1345 W BAY DR
Practice Address - Street 2:#101
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2282
Practice Address - Country:US
Practice Address - Phone:727-581-3550
Practice Address - Fax:727-586-6190
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5078207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046156300Medicaid
FL046156300Medicaid
DCD27408Medicare UPIN