Healthcare Provider Details

I. General information

NPI: 1326609017
Provider Name (Legal Business Name): HAILEY CHRISTA MERK MSM, MMS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 W HARRISON ST STE 400
CHICAGO IL
60612-4861
US

IV. Provider business mailing address

7737 W BIRCHWOOD AVE
CHICAGO IL
60631-4242
US

V. Phone/Fax

Practice location:
  • Phone: 312-432-2300
  • Fax: 708-409-5179
Mailing address:
  • Phone: 773-391-1908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: