Provider Information for 1598293839
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Ms. DENISE MARIE MERCHERSON
Sex: Female
NPI: 1598293839
Last Updated: 2022-07-21
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1598293839 | ||||||||
| Enumeration Date | 2017-05-31 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 11400 S. ST. LAWRENCE AVE CHICAGO, IL 60628 United States Phone: 312-402-5656 | Fax: | ||||||||
| Primary Practice Address | 9561 S. UNION CHICAGO, IL 60628 United States Phone: 708-799-0300 | Fax: | ||||||||
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