Provider Demographics
NPI:1104928498
Name:MERHI, NAHLA O (DR (MD))
Entity type:Individual
Prefix:DR
First Name:NAHLA
Middle Name:O
Last Name:MERHI
Suffix:
Gender:F
Credentials:DR (MD)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 SILVER CROSS BLVD.
Mailing Address - Street 2:SUITE #375
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451
Mailing Address - Country:US
Mailing Address - Phone:815-717-8727
Mailing Address - Fax:815-717-8722
Practice Address - Street 1:1890 SILVER CROSS BLVD.
Practice Address - Street 2:SUITE #375
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451
Practice Address - Country:US
Practice Address - Phone:815-717-8727
Practice Address - Fax:815-717-8722
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107262207V00000X
IL036-107262207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1401089841OtherCLIA#
IL036107262Medicaid
H63589Medicare UPIN
ILH63589Medicare UPIN
ILK44404Medicare PIN