Healthcare Provider Details

I. General information

NPI: 1255235743
Provider Name (Legal Business Name): MR. ELIJAH WILLIAM MERCERJONES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 COBB ST
CADILLAC MI
49601-2540
US

IV. Provider business mailing address

527 COBB ST
CADILLAC MI
49601-2540
US

V. Phone/Fax

Practice location:
  • Phone: 231-631-3137
  • Fax: 231-775-1692
Mailing address:
  • Phone: 231-631-3137
  • Fax: 231-775-1692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: