Basic Information
| Provider Information | |||||||||
| NPI: | 1154506731 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERING | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 W SUPERIOR | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523395267 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1663 BELVIDERE RD | ||||||||
| Address2: | |||||||||
| City: | BELVIDERE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610089306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8155440040 | ||||||||
| FaxNumber: | 8155440048 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2008 | ||||||||
| LastUpdateDate: | 01/02/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.