Provider Demographics
NPI:1114669892
Name:MERCURIO, MICHAEL JAMES (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:MERCURIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8550 MARSHALL DR STE 220
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-9836
Mailing Address - Country:US
Mailing Address - Phone:816-334-8226
Mailing Address - Fax:913-495-3751
Practice Address - Street 1:7201 E 147TH ST
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-4204
Practice Address - Country:US
Practice Address - Phone:816-348-2260
Practice Address - Fax:913-495-3751
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2025024001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program