Provider Demographics
NPI:1558404616
Name:MERCADO, MICHAEL G (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:G
Last Name:MERCADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1002 S DILLARD ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3991
Mailing Address - Country:US
Mailing Address - Phone:407-877-3577
Mailing Address - Fax:407-877-8495
Practice Address - Street 1:1002 S DILLARD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3991
Practice Address - Country:US
Practice Address - Phone:407-877-3577
Practice Address - Fax:407-877-8495
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0057046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064075100Medicaid
FL064075100Medicaid
FLA61205Medicare UPIN