Provider Demographics
NPI:1891875761
Name:SHILL, MERTON ANTHONY (PHD)
Entity type:Individual
Prefix:DR
First Name:MERTON
Middle Name:ANTHONY
Last Name:SHILL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 BALDWIN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-3523
Mailing Address - Country:US
Mailing Address - Phone:734-662-0294
Mailing Address - Fax:734-769-8066
Practice Address - Street 1:924 BALDWIN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-3523
Practice Address - Country:US
Practice Address - Phone:734-662-0294
Practice Address - Fax:734-769-8066
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003005103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680H113140OtherBLUE CROSS PROVIDER ID.