Basic Information
Provider Information
NPI: 1578550281
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MERFELD
FirstName: JOHN
MiddleName: M.
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 200 1ST ST SW
Address2:  
City: ROCHESTER
State: MN
PostalCode: 559050002
CountryCode: US
TelephoneNumber: 6087850940
FaxNumber:  
Practice Location
Address1: 815 10TH ST S
Address2:  
City: LA CROSSE
State: WI
PostalCode: 546014764
CountryCode: US
TelephoneNumber: 6087829760
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/29/2005
LastUpdateDate: 11/11/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/11/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X38073WIY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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