Provider Demographics
NPI:1861453359
Name:MERRILLS, BRADLEY W (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:W
Last Name:MERRILLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 LAPEER AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-1208
Mailing Address - Country:US
Mailing Address - Phone:989-759-6400
Mailing Address - Fax:989-759-6423
Practice Address - Street 1:3175 W PROFESSIONAL DRIVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2823
Practice Address - Country:US
Practice Address - Phone:989-667-3777
Practice Address - Fax:989-667-9991
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301061522207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI073OtherCOMMUNITY CHOICE
1017360OtherMCLAREN HEALTH PLAN PROFE
MI4762091Medicaid
0998824OtherBAY COUNTY HEALTH PLAN
150962OtherGREAT LAKES HEALTH PLAN
0998824OtherHEALTHPLUS
1017362OtherMCLAREN HEALTHPLAN MONITO
4762073OtherMOLINA HEALTH CARE PROFES
5932486OtherAETNA
700G361110OtherBLUE CROSS
381908328OtherHCAP
MI4762073Medicaid
4762091OtherMOLINA HEALTH CARE MONITO
4762091OtherMOLINA HEALTH CARE MONITO
4762073OtherMOLINA HEALTH CARE PROFES
1017362OtherMCLAREN HEALTHPLAN MONITO