MEDICARE: MERCY HEALTH PARTNERS-OBSTETRICS AND GYNECOLOGY SPECIALIST

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207VX0000X	Obstetrics Physician
2	363L00000X	Nurse Practitioner
3	363A00000X	Physician Assistant
4	207VG0400X	Gynecology Physician
5	367A00000X	Advanced Practice Midwife
6	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1215255799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY HEALTH PARTNERS-OBSTETRICS AND GYNECOLOGY SPECIALIST

Provider Business Mailing Address
First Line	:	PO BOX 776982
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6982
Country	:	US
Telephone Number	:	800-494-5797
Fax Number	:

Provider Business Practice Location Address
First Line	:	1675 LEAHY ST STE 428B
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49442-5500
Country	:	US
Telephone Number	:	231-672-3300
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MICHAEL GUSHO
Credential	:
Telephone Number	:	734-398-0642

Provider Enumeration Date	:	05/10/2010
Last Update Date	:	03/05/2026

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