Individual
DR. EDMOND MERTZENICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1200 W STATE ST, ROCKFORD, IL 61102-2112
(815) 490-1600
(815) 490-1485
Mailing address
1200 W. STATE ST, CRUSADER COMMUNITY HEALTH, ROCKFORD, IL 61102-2112
(815) 490-1600
(815) 490-1485
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016003825
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016003825
—
IL
Enumeration date
11/23/2005
Last updated
07/30/2012
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