MEDICARE: MARK C MERING PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant		IL

General Provider Information

NPI Number	:	1154506731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK C MERING PA-C

Provider Business Mailing Address
First Line	:	815 W SUPERIOR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622
Country	:	US
Telephone Number	:	352-339-5267
Fax Number	:

Provider Business Practice Location Address
First Line	:	1663 BELVIDERE RD
Second Line	:
City	:	BELVIDERE
State	:	IL
Zip	:	61008-9306
Country	:	US
Telephone Number	:	815-544-0040
Fax Number	:	815-544-0048

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2008
Last Update Date	:	01/02/2008

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Directions to “ MARK C MERING PA-C” Practice Location

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