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General NPI Number Information
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NPI Number | 1265430730
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Entity Type | Organization
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Legal Business Name | MERCADO FOOT AND ANKLE CLINICS
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 4143 SAUK TRL
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City | RICHTON PARK
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State | IL
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Zip | 60471-1253
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Country | US
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Telephone | 708-748-3337
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Fax | 708-747-3338
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Provider Business Mailing Address
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Address Line | 4143 SAUK TRL
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City | RICHTON PARK
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State | IL
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Zip | 60471-1253
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Country | US
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Telephone | 708-748-3337
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Fax | 708-747-3338
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Authorized Official
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Title or Position | PODIATRIST/OWNER/PARTNER
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Name | MICHAEL JAMES SMITH
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Credential | DPM
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Telephone | 708-748-3337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State | IL
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