Basic Information
| Provider Information | |||||||||
| NPI: | 1861453359 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERRILLS | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 LAPEER AVE | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486071208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897596400 | ||||||||
| FaxNumber: | 9897596423 | ||||||||
| Practice Location | |||||||||
| Address1: | 3175 W PROFESSIONAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | BAY CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487062823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9896673777 | ||||||||
| FaxNumber: | 9896679991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2006 | ||||||||
| LastUpdateDate: | 04/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 4301061522 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 073 | 01 | MI | COMMUNITY CHOICE | OTHER | 1017360 | 01 | MCLAREN HEALTH PLAN PROFE | OTHER | 4762091 | 05 | MI | MEDICAID | 0998824 | 01 | BAY COUNTY HEALTH PLAN | OTHER | 150962 | 01 | GREAT LAKES HEALTH PLAN | OTHER | 0998824 | 01 | HEALTHPLUS | OTHER | 1017362 | 01 | MCLAREN HEALTHPLAN MONITO | OTHER | 4762073 | 01 | MOLINA HEALTH CARE PROFES | OTHER | 5932486 | 01 | AETNA | OTHER | 700G361110 | 01 | BLUE CROSS | OTHER | 381908328 | 01 | HCAP | OTHER | 4762073 | 05 | MI | MEDICAID | 4762091 | 01 | MOLINA HEALTH CARE MONITO | OTHER |