Provider Demographics
NPI:1457647133
Name:DONENBERG, MERRICK (MD)
Entity Type:Individual
Prefix:
First Name:MERRICK
Middle Name:
Last Name:DONENBERG
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 1:1050 E. NORRIS DR.
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:OTTWAW
Mailing Address - State:IL
Mailing Address - Zip Code:61350
Mailing Address - Country:US
Mailing Address - Phone:815-434-0276
Mailing Address - Fax:815-434-0319
Practice Address - Street 1:1050 E NORRIS DR STE 2C
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-1611
Practice Address - Country:US
Practice Address - Phone:815-434-0276
Practice Address - Fax:815-434-0319
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILD55155085037207R00000X
IL036135131207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine