Provider Demographics
NPI:1972501161
Name:MERLO, PATRICIA KATHERINE (DO)
Entity Type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:KATHERINE
Last Name:MERLO
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 1:1710 N RANDALL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4717
Mailing Address - Country:US
Mailing Address - Phone:847-214-5755
Mailing Address - Fax:847-214-9606
Practice Address - Street 1:1710 N RANDALL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4717
Practice Address - Country:US
Practice Address - Phone:847-214-5755
Practice Address - Fax:847-214-9606
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089508207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00143432OtherRAILROAD MEDICARE
IL04532170OtherBLUE CROSS BLUE SHIELD
IL036089508Medicaid
IL610033301OtherDOL WORKCOMP
ILDB0387OtherRAILROAD MEDICARE GROUP
ILG14892Medicare UPIN
IL208439Medicare ID - Type UnspecifiedGROUP LOCALITY 15
ILK04337Medicare ID - Type UnspecifiedLOCALITY 15