MEDICARE: RICHARD C MERTZ JR MD PC

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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1043395502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD C MERTZ JR MD PC

Provider Business Mailing Address
First Line	:	21711 GREATER MACK AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-2418
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21711 GREATER MACK AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-2418
Country	:	US
Telephone Number	:	586-774-0393
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JAMES W KLEIN
Credential	:	MD
Telephone Number	:	586-774-0393

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	06/17/2008

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