Provider Demographics
NPI:1619996824
Name:MERRILLWOOD PEDIATRICS PC
Entity Type:Organization
Organization Name:MERRILLWOOD PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTRY BLUJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-543-2403
Mailing Address - Street 1:27332 WOODWARD AVE
Mailing Address - Street 2:UNIT 100
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067
Mailing Address - Country:US
Mailing Address - Phone:248-543-1545
Mailing Address - Fax:248-543-8638
Practice Address - Street 1:27332 WOODWARD AVE
Practice Address - Street 2:UNIT 100
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067
Practice Address - Country:US
Practice Address - Phone:248-543-1545
Practice Address - Fax:248-543-8638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty