Healthcare Provider Details

I. General information

NPI: 1710909890
Provider Name (Legal Business Name): ALINA MERRILL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 S. EUCLID AVE 5TH FLOOR
BERWYN IL
60402
US

IV. Provider business mailing address

151 LE MOYNE PKWY
OAK PARK IL
60302-1158
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-2000
  • Fax: 708-783-3656
Mailing address:
  • Phone: 347-452-4017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036113104
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: