Basic Information
| Provider Information | |||||||||
| NPI: | 1710365358 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERLO | ||||||||
| FirstName: | ALEX | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1005 BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 623012834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2172238400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 640 W WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | PITTSFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 623631350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2172852113 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2015 | ||||||||
| LastUpdateDate: | 12/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 4301107174 | MI | N | Allopathic & Osteopathic Physicians | Surgery | 207Q00000X | 036147880 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.