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NPI Code Detail

MEDICARE: PATRICIA MERRIMAN

MEDICARE: PATRICIA MERRIMAN
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
1103T00000XPsychologist071-0006613IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1POO212259OTHERILMEDICARE RAILROAD NUMBER

General Provider Information

NPI Number : 1699871038
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA MERRIMAN
Provider Business Mailing Address
First Line : 1653 W CONGRESS PKWY
Second Line : 735 JELKE ANESTHESIA DEPARTMENT
City : CHICAGO
State : IL
Zip : 60612-3833
Country : US
Telephone Number : 312-942-6631
Fax Number : 312-942-5773
Provider Business Practice Location Address
First Line : 1653 W CONGRESS PKWY
Second Line : 735 JELKE ANESTHESIA DEPARTMENT
City : CHICAGO
State : IL
Zip : 60612-3833
Country : US
Telephone Number : 312-942-6631
Fax Number : 312-942-5773
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2006
Last Update Date : 05/10/2026

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Directions to “ PATRICIA MERRIMAN ” Practice Location

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