MEDICARE: JOSE A MERCADO-FRANCIS MD

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	208D00000X	General Practice Physician	4301078684	MI

General Provider Information

NPI Number	:	1114973955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE A MERCADO-FRANCIS MD

Provider Business Mailing Address
First Line	:	4276 HAVANA AVE SW
Second Line	:
City	:	WYOMING
State	:	MI
Zip	:	49509-4347
Country	:	US
Telephone Number	:	586-777-8801
Fax Number	:	586-777-9988

Provider Business Practice Location Address
First Line	:	23420 GREATER MACK AVE
Second Line	:
City	:	ST CLAIR SHORES
State	:	MI
Zip	:	48080-3424
Country	:	US
Telephone Number	:	586-777-8801
Fax Number	:	586-777-9988

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	07/08/2007

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