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Individual

MICHAEL GEORGE MERCURY

Active
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Individual

MICHAEL GEORGE MERCURY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHD

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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