Provider Demographics
NPI:1194908095
Name:CLAUDE E. MERRIN MD PC
Entity type:Organization
Organization Name:CLAUDE E. MERRIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MERRIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-588-8855
Mailing Address - Street 1:4015 N PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2456
Mailing Address - Country:US
Mailing Address - Phone:773-588-8855
Mailing Address - Fax:
Practice Address - Street 1:4015 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2456
Practice Address - Country:US
Practice Address - Phone:773-588-8855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL611050OtherMEDICARE GRP ID