| Rodrigo B Mata Iii, M.d., S.c. | |
|
6123 Green Bay Rd Ste 120 Kenosha WI 53142-2927 | |
| (262) 652-2710 | |
| (262) 652-1370 |
| Full Name | Rodrigo B Mata Iii, M.d., S.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 6123 Green Bay Rd Ste 120, Kenosha, Wisconsin |
| Authorized Official Name and Position | Rodrigo B Mata (M.D.) |
| Authorized Official Contact | 2626522710 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rodrigo B Mata Iii, M.d., S.c. 6123 Green Bay Rd Ste 120 Kenosha WI 53142-2927 Ph: (262) 652-2710 | Rodrigo B Mata Iii, M.d., S.c. 6123 Green Bay Rd Ste 120 Kenosha WI 53142-2927 Ph: (262) 652-2710 |
| NPI Number | 1588847099 |
|---|---|
| Provider Enumeration Date | 12/07/2007 |
| Last Update Date | 06/03/2020 |
| Medicare PECOS PAC ID | 9133024789 |
|---|---|
| Medicare Enrollment ID | O20031205000346 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588847099 | NPI | - | NPPES |
| 21286100 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 33893 (Wisconsin) | Primary |
| Provider Name | Rodrigo B Mata |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033148176 PECOS PAC ID: 6103721766 Enrollment ID: I20031211000097 |
Steven Schwimmer, Do Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5455 Sheridan Rd, 201, Kenosha, WI 53140 Phone: 262-654-2500 Fax: 252-654-2701 | |
Leilane U Sta Romana Mdsc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3734 7th Ave, Dominican Building Suite 15, Kenosha, WI 53140 Phone: 262-658-3706 | |
Genesis Medical Center Of Kenosha, S.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1020 35th St, Kenosha, WI 53140 Phone: 262-652-3500 Fax: 262-925-8353 | |
Great Lakes Family Medical Center Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6123 Green Bay Rd, Suite 120, Kenosha, WI 53142 Phone: 262-764-4390 Fax: 262-764-4396 | |
Gevinah Healthcare Sc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3100 Washington Rd, Kenosha, WI 53144 Phone: 310-933-5688 | |
Biji Joseph Md S C Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6935 70th Ct Unit 106, Kenosha, WI 53142 Phone: 262-344-4803 | |
Regina Capelli-scheidt M.d,s.c Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3601 30th Ave, Kenosha, WI 53144 Phone: 262-658-8862 Fax: 262-658-8874 |