Provider Demographics
NPI:1063010163
Name:MICHAEL J. MERDA
Entity type:Organization
Organization Name:MICHAEL J. MERDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MERDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-694-2074
Mailing Address - Street 1:338 W ALLEGAN ST
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MI
Mailing Address - Zip Code:49078-1012
Mailing Address - Country:US
Mailing Address - Phone:269-694-2074
Mailing Address - Fax:
Practice Address - Street 1:338 W ALLEGAN ST
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MI
Practice Address - Zip Code:49078-1012
Practice Address - Country:US
Practice Address - Phone:269-694-2074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental