Provider Demographics
NPI:1790898278
Name:MERCADO, ERLINDA PENALOSA (MD)
Entity Type:Individual
Prefix:
First Name:ERLINDA
Middle Name:PENALOSA
Last Name:MERCADO
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 1:2000 CHAMBERS ROAD
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-9296
Mailing Address - Country:US
Mailing Address - Phone:989-673-3191
Mailing Address - Fax:989-673-0064
Practice Address - Street 1:2000 CHAMBERS ROAD
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-9296
Practice Address - Country:US
Practice Address - Phone:989-673-3191
Practice Address - Fax:989-673-0064
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC834662084P0800X
MIEM0315142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104866882Medicaid
MI2606386671OtherBLUE CROSS BLUE SHIELD
MIP00027113OtherRAILROAD MEDICARE
MI0G96036060Medicare ID - Type UnspecifiedST OF MI DCH CARO CENTER
MIP00027113OtherRAILROAD MEDICARE