MEDICARE: LLOYD MERCADO ANP

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	363L00000X	Nurse Practitioner	209012347	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	13677101	OTHER	IL	CAQH

General Provider Information

NPI Number	:	1457749079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LLOYD MERCADO ANP

Provider Business Mailing Address
First Line	:	PO BOX 3603
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60522-3603
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2331 W CHICAGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-4723
Country	:	US
Telephone Number	:	773-772-7858
Fax Number	:	773-276-6668

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

Provider Enumeration Date	:	01/05/2015
Last Update Date	:	03/07/2023

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