Healthcare Provider Details

I. General information

NPI: 1649225186
Provider Name (Legal Business Name): PHILIP F MERK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W 10TH ST
INDIANAPOLIS IN
46202-2859
US

IV. Provider business mailing address

8910 PURDUE RD STE.500
INDIANAPOLIS IN
46268-6100
US

V. Phone/Fax

Practice location:
  • Phone: 317-630-7979
  • Fax: 317-630-2668
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License Number01024389
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01024389A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: