Provider Demographics
NPI:1316156318
Name:MERRITT DILLARD, DARCIA (DPM)
Entity type:Individual
Prefix:DR
First Name:DARCIA
Middle Name:
Last Name:MERRITT DILLARD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11030 W VILLA AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-2586
Mailing Address - Country:US
Mailing Address - Phone:414-371-1343
Mailing Address - Fax:
Practice Address - Street 1:11030 W VILLA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-2586
Practice Address - Country:US
Practice Address - Phone:414-467-7460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI664213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43216700Medicaid
WI00008500Medicare ID - Type Unspecified
WI43216700Medicaid