# RODRIGO B MATA III, M.D., S.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588847099
- **Authorized official:** DR. RODRIGO B MATA III M.D. (M.D.)
- **Authorized official phone:** (262) 652-2710

## Contact information

- **Practice address:** 6123 GREEN BAY RD STE 120, KENOSHA, WI 53142-2927
- **Practice address phone:** (262) 652-2710
- **Practice address fax:** (262) 652-1370
- **Mailing address:** 6123 GREEN BAY RD STE 120, KENOSHA, WI 53142-2927
- **Mailing address phone:** (262) 652-2710
- **Mailing address fax:** (262) 652-1370

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 33893 | WI | Yes |

## Other

- **Enumeration date:** 12/07/2007
- **Last updated:** 06/03/2020