Provider Demographics
NPI:1699722322
Name:ZETARUK, MERRILEE N (MD)
Entity type:Individual
Prefix:
First Name:MERRILEE
Middle Name:N
Last Name:ZETARUK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 KIRKBRIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WINNIPEG
Mailing Address - State:MB
Mailing Address - Zip Code:R3T5K2
Mailing Address - Country:CA
Mailing Address - Phone:204-254-5950
Mailing Address - Fax:
Practice Address - Street 1:14-160 MEADEWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:WINNIPEG
Practice Address - State:MB
Practice Address - Zip Code:R2M5L6
Practice Address - Country:CA
Practice Address - Phone:204-254-5950
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80596208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics