Provider Demographics
NPI:1467482323
Name:MERIC, ALBERT LOUIS III (MD)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:LOUIS
Last Name:MERIC
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:BERT
Other - Middle Name:LOUIS
Other - Last Name:MERIC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:16 WALNUT CRK
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-1046
Mailing Address - Country:US
Mailing Address - Phone:949-375-8996
Mailing Address - Fax:949-209-1980
Practice Address - Street 1:3931 LOUISIANA AVE S
Practice Address - Street 2:SUITE EAST 500
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4375
Practice Address - Country:US
Practice Address - Phone:952-993-2079
Practice Address - Fax:952-993-2701
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 018355207T00000X
MN50069207T00000X
CAC53082207T00000X
ND10495207T00000X
ARE-5123207T00000X
IA38056207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN067463200OtherMN MEDICAL ASSISTANCE
TN3076786Medicaid
TN3076786Medicaid
TN3076786Medicare ID - Type Unspecified