Healthcare Provider Details

I. General information

NPI: 1205041795
Provider Name (Legal Business Name): PILAR R. MERCADO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PILAR REBECCA MERCADO FULLER M.D.

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST 3200 W UICH MC 515
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

3846 N FRANCISCO AVE
CHICAGO IL
60618-3504
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-4020
  • Fax:
Mailing address:
  • Phone: 312-203-6504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036-104012
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number036104012
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: