Individual
MANUEL A MENDOZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1405 MILL ST, NEW LONDON, WI 54961-2155
(920) 531-2000
(920) 531-2030
Mailing address
707 14TH ST, BARABOO, WI 53913-1539
(608) 356-1400
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
38187
WI
207Q00000X
Family Medicine Physician
387187-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1009390
PHYS PLUS PROV #
WI
05
—
32248400
—
WI
01
—
70
DEANCARE PROV #
WI
01
—
930117017
RAILROAD MEDICARE PROV #
WI
Enumeration date
01/13/2006
Last updated
11/06/2020
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