MEDICARE: MR. EARL DEAN MERKEL 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	207Q00000X	Family Medicine Physician	04-11253	KS
2	208600000X	Surgery Physician	04-11253	KS

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
2	110498	OTHER	KS	BCBS GROUP
3	622440	OTHER	KS	ST GUARD
4	103168	OTHER	KS	BCBS PERSONAL
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396728028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EARL DEAN MERKEL MD

Provider Business Mailing Address
First Line	:	200 S MAIN ST
Second Line	:
City	:	RUSSELL
State	:	KS
Zip	:	67665-2920
Country	:	US
Telephone Number	:	785-483-3131
Fax Number	:	785-483-4859

Provider Business Practice Location Address
First Line	:	222 S KANSAS ST
Second Line	:	STE E
City	:	RUSSELL
State	:	KS
Zip	:	67665-3000
Country	:	US
Telephone Number	:	785-483-3333
Fax Number	:	785-483-4233

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

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	07/21/2022

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