Individual
JOSE M MENDIETA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
250 E LIBERTY ST, SUITE902, LOUISVILLE, KY 40202-1530
(502) 587-9140
(502) 587-9142
Mailing address
250 E LIBERTY ST, SUITE902, LOUISVILLE, KY 40202-1530
(502) 587-9140
(502) 587-9142
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
24590
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100351690A
—
IN
05
—
64245905
—
KY
Enumeration date
01/25/2006
Last updated
02/22/2010
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