Healthcare Provider Details

I. General information

NPI: 1659510865
Provider Name (Legal Business Name): MERCADO FOOT AND ANKLE CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3245 GROVE AVE STE 101102
BERWYN IL
60402-3474
US

IV. Provider business mailing address

3245 GROVE AVE STE 101102
BERWYN IL
60402-3474
US

V. Phone/Fax

Practice location:
  • Phone: 708-484-3599
  • Fax: 708-749-0727
Mailing address:
  • Phone: 708-484-3599
  • Fax: 708-749-0727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016004482
License Number StateIL

VIII. Authorized Official

Name: CYNTHIA M MERCADO
Title or Position: DPM
Credential: DPM
Phone: 708-484-3599