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NPI Code Detail

MEDICARE: MR. DOUGLAS MERENDA LRN

MEDICARE: MR. DOUGLAS MERENDA LRN
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
1163W00000XRegistered Nurse4704214700MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14704214700OTHERMISTATE LICENSE NUMBER

General Provider Information

NPI Number : 1861587347
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DOUGLAS MERENDA LRN
Provider Business Mailing Address
First Line : 26184 OUTER DR
Second Line :
City : LINCOLN PARK
State : MI
Zip : 48146-2084
Country : US
Telephone Number : 313-389-7500
Fax Number : 313-389-7510
Provider Business Practice Location Address
First Line : 26184 OUTER DR
Second Line :
City : LINCOLN PARK
State : MI
Zip : 48146-2084
Country : US
Telephone Number : 313-389-7500
Fax Number : 313-389-7510
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 11/16/2018

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Directions to “ MR. DOUGLAS MERENDA LRN” Practice Location

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