MEDICARE: DR. MICHAEL G 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	A93028	CA
2	207Q00000X	Family Medicine Physician	M-1568	GU

General Provider Information

NPI Number	:	1376533760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL G MERCADO M.D.

Provider Business Mailing Address
First Line	:	PSC 819 BOX 18
Second Line	:
City	:	FPO
State	:	AE
Zip	:	09645-0001
Country	:	US
Telephone Number	:	314-727-3546
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 836
Second Line	:
City	:	FPO
State	:	AE
Zip	:	09636-9998
Country	:	US
Telephone Number	:	314-624-3852
Fax Number	:

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	03/06/2025

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