Healthcare Provider Details

I. General information

NPI: 1063862985
Provider Name (Legal Business Name): JEFFREY MERZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST STE 16-738
CHICAGO IL
60611-3055
US

IV. Provider business mailing address

251 E HURON ST STE 16-738
CHICAGO IL
60611-3055
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-5924
  • Fax: 312-926-6134
Mailing address:
  • Phone: 312-926-5924
  • Fax: 312-926-6134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125068509
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036152033
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125068509
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: