Provider Demographics
NPI:1194894311
Name:PIACENTI, MERLE A (MD)
Entity type:Individual
Prefix:
First Name:MERLE
Middle Name:A
Last Name:PIACENTI
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:#8 US RTE 6 WEST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-2943
Mailing Address - Country:US
Mailing Address - Phone:815-223-5288
Mailing Address - Fax:815-220-0252
Practice Address - Street 1:600 E FIRST STREET
Practice Address - Street 2:ST MARGARETS HOSPITAL
Practice Address - City:SPRING VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61362-1512
Practice Address - Country:US
Practice Address - Phone:815-664-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360551412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00615598OtherBCBS
IL036055141Medicaid
663210OtherMEDICARE ID
00615598OtherBCBS
C41243Medicare UPIN