Healthcare Provider Details

I. General information

NPI: 1336105121
Provider Name (Legal Business Name): VIJA AUSTRA MERRILL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 W LIBERTY RD SUITE A
ANN ARBOR MI
48103-9746
US

IV. Provider business mailing address

3200 W LIBERTY RD SUITE A
ANN ARBOR MI
48103-9746
US

V. Phone/Fax

Practice location:
  • Phone: 734-994-5858
  • Fax: 734-994-4322
Mailing address:
  • Phone: 734-994-5858
  • Fax: 734-994-4322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301080218
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: