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NPI Code Detail

MEDICARE: MARC O. MERBAUM M.D.

MEDICARE: MARC O. MERBAUM M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician116179MO

General Provider Information

NPI Number : 1245204338
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARC O. MERBAUM M.D.
Provider Business Mailing Address
First Line : PO BOX 23340
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63156-3340
Country : US
Telephone Number : 314-843-7333
Fax Number : 314-843-9946
Provider Business Practice Location Address
First Line : 5034 GRIFFIN RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63128-3418
Country : US
Telephone Number : 314-843-7333
Fax Number : 314-843-9946
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2006
Last Update Date : 02/13/2017

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