MEDICARE: TERICA MERCADO

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	374700000X	Technician

General Provider Information

NPI Number	:	1174474613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERICA MERCADO

Provider Business Mailing Address
First Line	:	22800 67TH ST
Second Line	:
City	:	BANGOR
State	:	MI
Zip	:	49013-9806
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4234 CASCADE RD SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-8384
Country	:	US
Telephone Number	:	616-202-4840
Fax Number	:

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

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “ TERICA MERCADO ” Practice Location

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