Provider Demographics
NPI:1710909890
Name:MERRILL, ALINA (DO)
Entity Type:Individual
Prefix:
First Name:ALINA
Middle Name:
Last Name:MERRILL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 LE MOYNE PKWY
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1158
Mailing Address - Country:US
Mailing Address - Phone:347-452-4017
Mailing Address - Fax:
Practice Address - Street 1:3231 S. EUCLID AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402
Practice Address - Country:US
Practice Address - Phone:708-783-2000
Practice Address - Fax:708-783-3656
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine