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Individual

CARRIE D MENDOZA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
2525 S MICHIGAN AVE, CHICAGO, IL 60616-2315
(312) 567-2000
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(414) 389-2131

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
869
WI
207P00000X
Emergency Medicine Physician
DR 42658
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100048758
WI
05
85327824
CO
01
P00472353
RAILROAD MEDICARE
CO
Enumeration date
02/17/2006
Last updated
01/10/2022
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