Organization
MERCADO FOOT & ANKLE CLINIC WEST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. O. KENT MERCADO D.P.M. (DIRECTOR)
(630) 922-7722
Entity
Organization
Contact information
Practice address
24024 BRANCASTER DR, NAPERVILLE, IL 60564-8044
(630) 922-7722
(630) 922-7727
Mailing address
24024 BRANCASTER DR, NAPERVILLE, IL 60564-8044
(630) 922-7722
(630) 922-7727
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016004238
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016004238
—
IL
01
—
5180850001
ADMINASTAR DMERC #
IL
01
—
60001691
BC/BS PROVIDER #
IL
01
—
CI5229
RAILROAD MEDICARE GRP #
IL
Enumeration date
08/30/2006
Last updated
03/23/2016
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