Provider Demographics
NPI:1629170444
Name:EBUEN-MERCADO, DELIA R (MD)
Entity Type:Individual
Prefix:DR
First Name:DELIA
Middle Name:R
Last Name:EBUEN-MERCADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8447 HOLLY RD
Mailing Address - Street 2:STE E
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1888
Mailing Address - Country:US
Mailing Address - Phone:810-606-0601
Mailing Address - Fax:810-606-0627
Practice Address - Street 1:8447 HOLLY RD
Practice Address - Street 2:STE E
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1888
Practice Address - Country:US
Practice Address - Phone:810-606-0601
Practice Address - Fax:810-606-0627
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056778207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4195868Medicaid
MI4195868Medicaid
MIM23560114Medicare PIN