Provider Demographics
NPI:1326149436
Name:ALVAREZ, MERCEDES (MD)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27101 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-4730
Mailing Address - Country:US
Mailing Address - Phone:586-758-5800
Mailing Address - Fax:586-758-5841
Practice Address - Street 1:27101 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4730
Practice Address - Country:US
Practice Address - Phone:586-758-5800
Practice Address - Fax:586-758-5841
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301025795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1129519Medicaid
MI4749080Medicaid
MI0135001492OtherBCBSMI PERSONAL PIN
MIMA025795OtherLICENSE
MI1129519Medicaid
MI4749080Medicaid
MIP28360004Medicare PIN