Provider Demographics
NPI:1952758534
Name:MERTEN, MICHAEL (MS, ATC,)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MERTEN
Suffix:
Gender:M
Credentials:MS, ATC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 ECHOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-7107
Mailing Address - Country:US
Mailing Address - Phone:618-570-8434
Mailing Address - Fax:618-451-6296
Practice Address - Street 1:3101 MADISON AVE
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-3620
Practice Address - Country:US
Practice Address - Phone:618-451-5808
Practice Address - Fax:618-451-6296
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960002932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer