Individual
RODRIGO A MATA JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6123 GREEN BAY RD, SUITE 120, KENOSHA, WI 53142-2927
(262) 652-6995
(262) 652-1370
Mailing address
6123 GREEN BAY RD, SUITE 120, KENOSHA, WI 53142-2927
(262) 652-6995
(262) 652-1370
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22023-20
WI
Other
Enumeration date
11/04/2010
Last updated
11/04/2010
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