Healthcare Provider Details

I. General information

NPI: 1265430730
Provider Name (Legal Business Name): MERCADO FOOT AND ANKLE CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4143 SAUK TRL
RICHTON PARK IL
60471-1253
US

IV. Provider business mailing address

4143 SAUK TRL
RICHTON PARK IL
60471-1253
US

V. Phone/Fax

Practice location:
  • Phone: 708-748-3337
  • Fax: 708-747-3338
Mailing address:
  • Phone: 708-748-3337
  • Fax: 708-747-3338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateIL

VIII. Authorized Official

Name: MICHAEL JAMES SMITH
Title or Position: PODIATRIST/OWNER/PARTNER
Credential: DPM
Phone: 708-748-3337