Healthcare Provider Details

I. General information

NPI: 1780801514
Provider Name (Legal Business Name): BRAD M MERKER PH. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FORD PL # 1E
DETROIT MI
48202-3450
US

IV. Provider business mailing address

1 FORD PL # 1E
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 734-642-8659
  • Fax:
Mailing address:
  • Phone: 734-642-8659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6301013684
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: