MEDICARE: DR. MARY HAVEN MERKLE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	K0133	TX
2	208M00000X	Hospitalist Physician	K0133	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164406732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY HAVEN MERKLE MD

Provider Business Mailing Address
First Line	:	4299 SAN FELIPE
Second Line	:	SUITE 300
City	:	HOUSTON
State	:	TX
Zip	:	77027-2916
Country	:	US
Telephone Number	:	832-476-3900
Fax Number	:	832-476-3900

Provider Business Practice Location Address
First Line	:	710 FM 1960 WEST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3402
Country	:	US
Telephone Number	:	281-440-2692
Fax Number	:	281-440-2653

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	03/05/2010

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