Provider Demographics
NPI:1669715298
Name:MERTON A SHILL PHD, PLLC
Entity type:Organization
Organization Name:MERTON A SHILL PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MERTON
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SHILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:734-662-0294
Mailing Address - Street 1:924 BALDWIN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-3523
Mailing Address - Country:US
Mailing Address - Phone:734-662-0294
Mailing Address - Fax:
Practice Address - Street 1:924 BALDWIN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-3523
Practice Address - Country:US
Practice Address - Phone:734-662-0294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003005103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty