Provider Demographics
NPI:1194719633
Name:MERRIN, MICHAEL LEE (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:MERRIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50706
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93150-0706
Mailing Address - Country:US
Mailing Address - Phone:805-963-3757
Mailing Address - Fax:805-564-3332
Practice Address - Street 1:1919 STATE STREET
Practice Address - Street 2:SUITE 302
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2430
Practice Address - Country:US
Practice Address - Phone:805-563-9814
Practice Address - Fax:805-563-9838
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG18945207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G189450Medicaid
A40467Medicare UPIN
CAG18945Medicare ID - Type Unspecified
FK101ZMedicare PIN