Individual
MICHAEL GEORGE MERCURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
25 N WINFIELD RD, WINFIELD, IL 60190-1295
(630) 933-4056
(630) 933-4057
Mailing address
25 N WINFIELD RD, WINFIELD, IL 60190-1295
(630) 933-4056
(630) 933-4057
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
071005518
IL
103G00000X
Clinical Neuropsychologist
Primary
071005518
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
071005518
—
IL
01
—
206147
MEDICARE (GROUP PTAN)
IL
01
—
F400101012
MEDICARE (INDIVIDUAL PTAN)
IL
Enumeration date
11/28/2006
Last updated
01/22/2018
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