MEDICARE: MRS. SUZANNE 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	207N00000X	Dermatology Physician	BM4889804	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G02105	OTHER		BCN

General Provider Information

NPI Number	:	1184674798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUZANNE MERKLE MD

Provider Business Mailing Address
First Line	:	6330 ORCHARD LAKE RD
Second Line	:	#120
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-2398
Country	:	US
Telephone Number	:	248-855-3366
Fax Number	:	248-855-6213

Provider Business Practice Location Address
First Line	:	6330 ORCHARD LAKE RD
Second Line	:	#120
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-2398
Country	:	US
Telephone Number	:	248-855-3366
Fax Number	:	248-855-6213

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	11/18/2020

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