1023156445 NPI number — LAILA KATHERINE MERZ PH.D

Table of content: LAILA KATHERINE MERZ PH.D (NPI 1023156445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023156445 NPI number — LAILA KATHERINE MERZ PH.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERZ
Provider First Name:
LAILA
Provider Middle Name:
KATHERINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MERZ
Provider Other First Name:
LAILA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023156445
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15455 MANCHESTER RD
Provider Second Line Business Mailing Address:
#3311
Provider Business Mailing Address City Name:
BALLWIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63011-1546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9890 CLAYTON RD # 134
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63124-1685
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-222-5852
Provider Business Practice Location Address Fax Number:
314-222-5853
Provider Enumeration Date:
02/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TB0200X , with the licence number:  2001024795 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)