=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760588891
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. CYNTHIA M MERCADO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2006
-----------------------------------------------------
Last Update Date | 02/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3245 S GROVE AVE STE #101/102 MERCADO FOOT AND ANKLE CLINICS
-----------------------------------------------------
City | BERWYN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-484-3599
-----------------------------------------------------
Fax | 708-749-0727
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3245 S GROVE AVE STE #101/102 MERCADO FOOT AND ANKLE CLINICS
-----------------------------------------------------
City | BERWYN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-484-3599
-----------------------------------------------------
Fax | 708-749-0727
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 016004482
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------