Provider Demographics
NPI:1841244548
Name:MERRILL, BARBARA LOUISE (DO)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:LOUISE
Last Name:MERRILL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:BARBARA
Other - Middle Name:LOUISE
Other - Last Name:MERRILL-FONGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1650 HASLETT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HASLETT
Mailing Address - State:MI
Mailing Address - Zip Code:48840-8438
Mailing Address - Country:US
Mailing Address - Phone:517-339-3200
Mailing Address - Fax:517-339-4321
Practice Address - Street 1:1650 HASLETT RD
Practice Address - Street 2:SUITE 1
Practice Address - City:HASLETT
Practice Address - State:MI
Practice Address - Zip Code:48840-8438
Practice Address - Country:US
Practice Address - Phone:517-339-3200
Practice Address - Fax:517-339-4321
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011052207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF57831Medicare UPIN