Provider Demographics
NPI:1558329276
Name:MERCADO, RAMIRO O (MD)
Entity Type:Individual
Prefix:MR
First Name:RAMIRO
Middle Name:O
Last Name: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 1:1000 REMINGTON BLVD. STE 100
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440
Mailing Address - Country:US
Mailing Address - Phone:630-914-2898
Mailing Address - Fax:630-914-2469
Practice Address - Street 1:2259 N CICERO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-3327
Practice Address - Country:US
Practice Address - Phone:773-622-0056
Practice Address - Fax:773-622-1095
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085501207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085501Medicaid
ILF47250Medicare UPIN