Provider Demographics
NPI:1659335016
Name:MERRILD, BRANDT NEIL (MD)
Entity Type:Individual
Prefix:
First Name:BRANDT
Middle Name:NEIL
Last Name:MERRILD
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 1:303 E NICOLLET BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4522
Mailing Address - Country:US
Mailing Address - Phone:952-460-4000
Mailing Address - Fax:952-460-4000
Practice Address - Street 1:303 E NICOLLET BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4522
Practice Address - Country:US
Practice Address - Phone:952-460-4000
Practice Address - Fax:952-460-4000
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20923207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN150383900Medicaid
D48817Medicare UPIN
110003567Medicare ID - Type Unspecified