Healthcare Provider Details

I. General information

NPI: 1780662049
Provider Name (Legal Business Name): RICHARD J MERSCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 10TH STREET SE LEVEL 4, LUNDY PAVILION
CEDAR RAPIDS IA
52403
US

IV. Provider business mailing address

701 10TH STREET SE LEVEL 4, LUNDY PAVILION
CEDAR RAPIDS IA
52403
US

V. Phone/Fax

Practice location:
  • Phone: 319-861-7900
  • Fax: 319-861-7950
Mailing address:
  • Phone: 319-861-7900
  • Fax: 319-861-7950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35830
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0442962
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 2
Identifier1780662049
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: