Individual
DR. RODRIGO BUENCAMINO MATA III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6123 GREEN BAY RD, SUITE 120, KENOSHA, WI 53142-2927
(262) 652-2710
Mailing address
6123 GREEN BAY RD, SUITE 120, KENOSHA, WI 53142-2927
(262) 652-2710
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
33893
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21286100
—
WI
01
—
508901078009
BC/BS
WI
Enumeration date
07/01/2006
Last updated
06/03/2020
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