Provider Demographics
NPI:1760588891
Name:MERCADO, CYNTHIA M
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:M
Last Name:MERCADO
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:CYNTHIA
Other - Middle Name:M
Other - Last Name:MERCADO-CIESSAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3245 S GROVE AVE
Mailing Address - Street 2:STE #101/102 MERCADO FOOT AND ANKLE CLINICS
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402
Mailing Address - Country:US
Mailing Address - Phone:708-484-3599
Mailing Address - Fax:708-749-0727
Practice Address - Street 1:3245 S GROVE AVE
Practice Address - Street 2:STE #101/102 MERCADO FOOT AND ANKLE CLINICS
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402
Practice Address - Country:US
Practice Address - Phone:708-484-3599
Practice Address - Fax:708-749-0727
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004482213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004482Medicaid
IL209721Medicare ID - Type Unspecified
IL016004482Medicaid