Debartolo, Merrit Marion

Debartolo, Merrit Marion is an individual health care provider with primary practice located at 2000 Lake Ave , Woodstock IL 60098-7401. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Debartolo, Merrit Marion can be contacted via phone (815) 337-7100.

Contact Information

Primary practice address
2000 Lake Ave Woodstock IL 60098-7401
Phone: (815) 337-7100
Fax: (815) 337-4793
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Urology 208800000X 036-140512 Illinois
Allopathic & Osteopathic Physicians / Urology 208800000X 65614 Wisconsin

Profile Details

NPI number 1427379189
LBN Legal business name Debartolo, Merrit Marion
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 17th, 2010
Last updated Mar 17th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1427379189 NPPES
Wisconsin MEDICAID 1427379189

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