DR. MERRIT MARION DEBARTOLO (NPI# 1427379189) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427379189 |
| Entity Type | Individual |
| Full Name | DR. MERRIT MARION DEBARTOLO |
| Credential | MD |
| Practice Address |
2000 Lake Ave Woodstock IL 60098-7401 |
| Practice Telephone | 8153377100 |
| Practice Fax Number | 8153374793 |
| Mailing Telephone | 8153377100 |
| Mailing Fax Number | 8153374793 |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | 036-140512 | IL | Allopathic & Osteopathic Physicians |
| N | 208800000X | Urology | 65614 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 1427379189 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 10400 75th St, Kenosha, WI 531427884 | 2629486990 |
| Street Address |
2000 LAKE AVE |
| City | WOODSTOCK |
| State | IL |
| Zip Code | 60098-7401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750389953 | Anil K Khemani | Internal Medicine | 2000 Lake Ave, Woodstock, IL 60098-7401 | 2005-07-12 |
| 1497373286 | Michelle T Gahgan | Nurse Practitioner | 2000 Lake Ave, Woodstock, IL 60098-7401 | 2020-07-08 |
| 1417456476 | Matthew R. Banks | Physical Therapy Assistant | 2000 Lake Ave, Woodstock, IL 60098-7401 | 2018-02-06 |
| 1801247176 | Guoqing Song | Physician Assistant | 2000 Lake Ave, Woodstock, IL 60098-7401 | 2016-06-28 |
| 1114398930 | Norman J Mecwan | Physical Therapist | 2000 Lake Ave, Woodstock, IL 60098-7401 | 2015-10-20 |
| 1669883971 | Jenna M Raju | Physician Assistant | 2000 Lake Ave, Woodstock, IL 60098-7401 | 2014-05-09 |
| 1508281114 | Lawrence Thomas Walsh Jr. | Pharmacist | 2000 Lake Ave, Woodstock, IL 60098-7401 | 2014-02-19 |
| 1548696404 | Laura Lynn Dickman | Registered Nurse | 2000 Lake Ave, Woodstock, IL 60098-7401 | 2013-09-23 |
| 1922346220 | Naomi M Tamparong | Registered Nurse | 2000 Lake Ave, Woodstock, IL 60098-7401 | 2013-01-21 |
| 1649523838 | Kelly Marie Winkelman | Registered Nurse | 2000 Lake Ave, Woodstock, IL 60098-7401 | 2012-10-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083197453 | Abb Dental Group LLC | Dentist | 11585 Us 14, Woodstock, IL 60098 | 2018-09-12 |
| 1396256467 | Gezelle Adams | Social Worker | 1200 Walden Oaks Dr, Woodstock, IL 60098 | 2017-10-17 |
| 1861910721 | Letitia Susan Edgell | Technician | 503 Lawndale Ave., Woodstock, IL 60098 | 2017-08-31 |
| 1104355460 | Jessica Evertsen | Doula | 435 Laurel Ave, Woodstock, IL 60098 | 2017-06-08 |
| 1871026724 | Bo Yeon Bartilotta | Dentist | 11585 Us-14, Woodstock, IL 60098 | 2017-04-07 |
| 1619337185 | Julia Karibian | Community Health Worker | 2983 Strauss Court, Woodstock, IL 60098 | 2016-02-26 |
| 1407249170 | Julia Bonti | Counselor | 13318 Hickory Ln, Woodstock, IL 60098 | 2015-03-05 |
| 1427485580 | Sara E Smedinghoff | Physical Therapy Assistant | 708 Washington Street, Woodstock, IL 60098 | 2013-10-03 |
| 1669721783 | Robert Eugene Haraden | Dentist | 651 S. Eastwood Dr, Woodstock, IL 60098 | 2012-09-05 |
| 1831447440 | Carla Peltier | Social Worker | 101 South Jefferson Street, Woodstock, IL 60098 | 2012-08-29 |
| Find all providers in zip 60098 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205910130 | Michael J Karasis M.d. S.c. | Urology | 526 W South St, Woodstock, IL 60098-3749 | 2006-10-25 |
| 1316162506 | Georgia Urology Pa | Urology | 900 Towne Lake Pkwy, Suite 200, Woodstock, GA 30189-1600 | 2007-04-15 |
| 1992822308 | Shenandoah Memorial Hospital | Urology | 759 S Main St, Woodstock, VA 22664-1127 | 2007-03-23 |
| 1003990953 | Michael J Karasis | Urology | 526 W South St, Woodstock, IL 60098-3749 | 2006-10-25 |
| 1124048111 | Jeffrey B Asbury | Urology | 2000 Lake Ave, Woodstock, IL 60098-7401 | 2006-07-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699236612 | Behdod Katebian | Urology | 5841 S Maryland Ave Rm J-653, Chicago, IL 60637-1443 | 2019-03-31 |
| 1912436015 | Robert Ara Petrossian | Urology | 301 N 8th St # 4b143c, Springfield, IL 62701-1041 | 2017-06-12 |
| 1134657026 | Soojin Kim | Urology | 225 E. Chicago Avenue, Box 24, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611 | 2017-05-23 |
| 1619337912 | George Robert Buckun | Urology | 930 Rogers St., #301, Downers Grove, IL 60515 | 2016-02-29 |
| 1275991606 | Nicole Alyssa Hamilton | Urology | 22285 N Pepper Rd Ste 201, Lake Barrington, IL 60010-2540 | 2016-01-30 |
| 1790164002 | Shay Golan | Urology | 5841 S Maryland Ave Mc6038, Chicago, IL 60637-1447 | 2015-05-20 |
| 1528453594 | Christopher Stockdale | Urology | 300 W Hill St Apt 707, Chicago, IL 60610-7537 | 2015-04-06 |
| 1639568447 | Jeremy Lai | Urology | 420 E Superior St Ste 9-900, Chicago, IL 60611-4494 | 2015-01-16 |
| 1386053759 | Ramiro Felix Prudencio | Urology | 1200 Broadmeadow Rd, Winnetka, IL 60093-3707 | 2014-08-10 |
| 1174933048 | Kyle John Ericson | Urology | 924 E 57th St, Suite 104, Chicago, IL 60637-1455 | 2014-05-01 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.