Healthcare Provider Details

I. General information

NPI: 1942566419
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL MERRICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 E BOULDER ST STE 204
COLORADO SPRINGS CO
80909-5756
US

IV. Provider business mailing address

1725 E BOULDER ST STE 204
COLORADO SPRINGS CO
80909-5756
US

V. Phone/Fax

Practice location:
  • Phone: 719-471-1069
  • Fax:
Mailing address:
  • Phone: 719-471-1069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number53572
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberDR.0059206
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: