Healthcare Provider Details

I. General information

NPI: 1457260986
Provider Name (Legal Business Name): VINCENT MERCADO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WINDING CANYON WAY
ALGONQUIN IL
60102-5045
US

IV. Provider business mailing address

400 WINDING CANYON WAY
ALGONQUIN IL
60102-5045
US

V. Phone/Fax

Practice location:
  • Phone: 847-961-8788
  • Fax:
Mailing address:
  • Phone: 847-961-8788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number31044
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: