Provider Demographics
NPI:1164477584
Name:MARTINEZ-MERCADO, FELIX (MD)
Entity Type:Individual
Prefix:DR
First Name:FELIX
Middle Name:
Last Name:MARTINEZ-MERCADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 WESTLOOP PL # 354
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2840
Mailing Address - Country:US
Mailing Address - Phone:785-537-9600
Mailing Address - Fax:785-537-9643
Practice Address - Street 1:2310 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2967
Practice Address - Country:US
Practice Address - Phone:785-537-9600
Practice Address - Fax:785-537-9643
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-207502084P0800X
KSKS-04-207502084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSC79315Medicare UPIN
KS049751Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
742982981OtherEIN