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General NPI Number Information
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NPI Number | 1184872046
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Entity Type | Individual
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Provider Name | LYDIA K MERTZ MD
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Gender | Female
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Dates
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Enumeration Date | 09/04/2008
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 608 OAKLAND AVE
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City | ELKHART
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State | IN
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Zip | 46516-3819
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Country | US
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Telephone | 574-523-2127
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Fax | 574-522-2192
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Provider Business Mailing Address
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Address Line | 1130 PROFESSIONAL DR
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City | GOSHEN
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State | IN
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Zip | 46526-3819
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01031929A
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License Number State | IN
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