Provider Demographics
NPI:1942287099
Name:MERCHO, TONY H (MD)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:H
Last Name:MERCHO
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 1:1311 N ARLINGTON AVE
Mailing Address - Street 2:SUITE # 108
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-3286
Mailing Address - Country:US
Mailing Address - Phone:317-357-7800
Mailing Address - Fax:
Practice Address - Street 1:1311 N ARLINGTON AVE
Practice Address - Street 2:SUITE # 108
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3286
Practice Address - Country:US
Practice Address - Phone:317-357-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046737207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN352024038OtherTIN
G67475Medicare UPIN