Provider Demographics
NPI:1275633737
Name:MERSICH, KARL TQ (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:TQ
Last Name:MERSICH
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 1:2884 WELLNESS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8397
Mailing Address - Country:US
Mailing Address - Phone:386-668-2221
Mailing Address - Fax:386-668-2228
Practice Address - Street 1:2884 WELLNESS AVE STE 100
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8397
Practice Address - Country:US
Practice Address - Phone:386-668-2221
Practice Address - Fax:386-668-2228
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177994-1207RG0100X
FL134072207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01252744Medicaid
E47368Medicare UPIN
NY01252744Medicaid