Provider Demographics
NPI:1467466227
Name:MERRITT, THOMAS R (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:MERRITT
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 1:230 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-1597
Mailing Address - Country:US
Mailing Address - Phone:231-924-4200
Mailing Address - Fax:231-924-4064
Practice Address - Street 1:230 W. OAK ST.
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-1597
Practice Address - Country:US
Practice Address - Phone:231-924-4200
Practice Address - Fax:231-924-4064
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24119207X00000X
MI1082387207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902695Medicaid
MI5447137Medicaid
MI5447137Medicaid
NC5902695Medicaid
MIC01981Medicare UPIN
MI0F26007Medicare PIN