MEDICARE: CARLOS MERCADO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME 73229	FL
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	ME 73229	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033139100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS MERCADO M.D.

Provider Business Mailing Address
First Line	:	1307 S. INTERNATIONAL PKWY
Second Line	:	SUITE 2091
City	:	LAKE MARY
State	:	FL
Zip	:	32746-1414
Country	:	US
Telephone Number	:	407-771-0404
Fax Number	:	407-771-0405

Provider Business Practice Location Address
First Line	:	1307 S INTERNATIONAL PKWY
Second Line	:	SUITE 2091
City	:	LAKE MARY
State	:	FL
Zip	:	32746-1413
Country	:	US
Telephone Number	:	407-771-0404
Fax Number	:	407-771-0405

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	11/06/2008

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Directions to “ CARLOS MERCADO M.D.” Practice Location

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