Organization
RODRIGO B MATA III, M.D., S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RODRIGO B MATA III M.D. (M.D.)
(262) 652-2710
Entity
Organization
Contact information
Practice address
6123 GREEN BAY RD STE 120, KENOSHA, WI 53142-2927
(262) 652-2710
(262) 652-1370
Mailing address
6123 GREEN BAY RD STE 120, KENOSHA, WI 53142-2927
(262) 652-2710
(262) 652-1370
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
Enumeration date
12/07/2007
Last updated
06/03/2020
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