DR. EDMOND MERTZENICH (NPI# 1558344598) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558344598 |
| Entity Type | Individual |
| Full Name | DR. EDMOND MERTZENICH |
| Other Name | DR. EDMOND MERTZENICH |
| Credential | DPM |
| Practice Address |
1200 W State St Rockford IL 61102-2112 |
| Mailing Address |
1200 W. State St Crusader Community Health Rockford IL 61102-2112 |
| Practice Telephone | 8154901600 |
| Practice Fax Number | 8154901485 |
| Mailing Telephone | 8154901600 |
| Mailing Fax Number | 8154901485 |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2012-07-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213E00000X | Podiatrist | 016003825 | IL | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 016003825 | 05 |
| Street Address |
1200 W STATE ST |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61102-2112 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780680827 | Barbara B Morgan | Nurse Practitioner | 1200 W State St, Rockford, IL 61102-2112 | 2005-06-23 |
| 1588271894 | Angela Siebold | Nurse Practitioner | 1200 W State St, Rockford, IL 61102-2112 | 2020-09-30 |
| 1942814322 | Jacqueline Paige Cabrera | Nurse Practitioner | 1200 W State St, Rockford, IL 61102-2112 | 2020-09-03 |
| 1285250951 | Aaleeyah Pringle Alim | Dentist | 1200 W State St, Rockford, IL 61102-2112 | 2020-06-18 |
| 1639792419 | Jessica Lauren Cole | Physician Assistant | 1200 W State St, Rockford, IL 61102-2112 | 2020-05-27 |
| 1437779071 | Christian Murillo | Physician Assistant | 1200 W State St, Rockford, IL 61102-2112 | 2020-04-23 |
| 1033746573 | Erin Ashleigh Donahue | Physician Assistant | 1200 W State St, Rockford, IL 61102-2112 | 2020-03-25 |
| 1609406008 | Marissa Dreger | Family Medicine | 1200 W State St, Rockford, IL 61102-2112 | 2020-01-24 |
| 1962041657 | Sabrina Lee Puvalowski | Physician Assistant | 1200 W State St, Rockford, IL 61102-2112 | 2019-12-30 |
| 1932741717 | Jacob Dalton Boehm | Physician Assistant | 1200 W State St, Rockford, IL 61102-2112 | 2019-10-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205115383 | Renee Lynn Keeney | Advanced Practice Midwife | 1200 W. State Street, Crusader Community Health, Rockford, IL 61102 | 2011-08-08 |
| 1689895906 | Linda Lou O'reilly | Local Education Agency (LEA) | 1515 S. Meridian Road, Rockford, IL 61102 | 2007-05-02 |
| 1801012992 | Jennifer Anne Boyd | Developmental Therapist | Nia 1515 S. Meridian Rd., Rockford, IL 61102 | 2007-04-17 |
| 1609173434 | Kellie J Gibbons | Registered Nurse | 650 W State Street, Winnebago County Jail Medical Unit, Rockford, IL 61102-0000 | 2011-02-14 |
| 1275708752 | Mercy Ambulance Service LLC | Ambulance | 1025 Campton Dr, Rockford, IL 61102-1066 | 2008-04-25 |
| 1417448424 | Brittany Nicole Lambert | Student in an Organized Health Care Education/Training Program | 8040 Towermont Dr, Rockford, IL 61102-1080 | 2018-05-24 |
| 1164490132 | Harlan Johnson | Counselor | 852 Lakewood Dr, Rockford, IL 61102-1228 | 2006-03-08 |
| 1184137283 | Gail Mary Swenson | Speech-Language Pathologist | 730 Lincoln Park Blvd, Rockford, IL 61102-1429 | 2017-11-10 |
| 1659316339 | Institute of Family Care | Home Health | 417 S Pierpont Ave, Rockford, IL 61102-1656 | 2006-06-18 |
| 1861851438 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1200 W State St Ste 102, Rockford, IL 61102-2112 | 2016-02-11 |
| Find all providers in zip 61102 | ||||
| Taxonomy Code | 213E00000X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265895239 | Richard Bell | Podiatrist | 6055 Boxwood Dr, Rockford, IL 61114-6559 | 2016-03-29 |
| 1801025473 | Nathan Norem | Podiatrist | 2300 N Rockten Ave, Rockford, IL 61103-3619 | 2009-07-05 |
| 1508967621 | Matthew S. Keene | Podiatrist | 4777 East State Street, Suite 8, Rockford, IL 61108 | 2006-09-25 |
| 1497854053 | Philip W Seeber | Podiatrist | 3851 N Mulford, Rockford, IL 61114 | 2006-09-21 |
| 1215042965 | Paul A Galluzzo | Podiatrist | 6999 Redansa Drive, Rockford, IL 61108-1201 | 2006-08-21 |
| 1497731293 | Thomas A Runne | Podiatrist | 1437 S Bell School Rd Ste 2, Rockford, IL 61108-1405 | 2005-12-22 |
| 1316507890 | Ashley Ann Smith | Podiatrist | 324 Roxbury Rd, Rockford, IL 61107-5090 | 2019-06-18 |
| 1922668755 | Jacob Russell Randich | Podiatrist | 5666 E State St, Rockford, IL 61108-2425 | 2019-06-14 |
| 1184144727 | Donald C Bisby | Podiatrist | 324 Roxbury Rd, Rockford, IL 61107-5090 | 2017-06-25 |
| 1700239332 | Tiphani James | Podiatrist | 5666 E State St, Rockford, IL 61108-2425 | 2016-07-19 |
| Find all providers in ROCKFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.