Provider Demographics
NPI:1962719419
Name:MERCADO, JUAN P (APN)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:P
Last Name:MERCADO
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2943 W 71ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-3047
Mailing Address - Country:US
Mailing Address - Phone:630-842-2614
Mailing Address - Fax:
Practice Address - Street 1:164 DIVISION ST
Practice Address - Street 2:607
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-5587
Practice Address - Country:US
Practice Address - Phone:847-695-1093
Practice Address - Fax:847-695-0501
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008311363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily