RODRIGO B MATA III, M.D., S.C. (NPI# 1588847099) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588847099 |
| Entity Type | Organization |
| Organization Name | RODRIGO B MATA III, M.D., S.C. |
| Practice Address |
6123 Green Bay Rd Ste 120 Kenosha WI 53142-2927 |
| Practice Telephone | 2626522710 |
| Practice Fax Number | 2626521370 |
| Mailing Telephone | 2626522710 |
| Mailing Fax Number | 2626521370 |
| Enumeration Date | 2007-12-07 |
| Last Update Date | 2020-06-03 |
| Authorized Official Name | DR. RODRIGO B MATA III (M.D.) |
| Authorized Official Telephone | 2626522710 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 33893 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 21286100 | 05 |
| Street Address |
6123 GREEN BAY RD STE 120 |
| City | KENOSHA |
| State | WI |
| Zip Code | 53142-2927 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588297816 | Caring Hearts Home Health Care | In Home Supportive Care | 6021-57th Ave, Suite C103, Kenosha, WI 53142 | 2020-02-14 |
| 1144785395 | Michael L Wrzesinski | Counselor | 4109 67th Street, Kenosha, WI 53142 | 2019-02-01 |
| 1720538499 | David Smith | Counselor | 10900 67th Street, Kenosha, WI 53142 | 2016-10-06 |
| 1326404641 | Smile Doctors Ltd | Dentist | 7003 39th Ave, Kenosha, WI 53142 | 2016-01-04 |
| 1225409485 | Antonia Marie Decker | Physician Assistant | 10400 75th St. Ste 204, Kenosha, WI 53142 | 2015-10-14 |
| 1780060582 | Joshua Haas | Pharmacist | 7701 Green Bay Road, Kenosha, IL 53142 | 2015-08-04 |
| 1811379225 | Dana Mary Stout | Registered Nurse | 7401 104th Avenue, Suite 110, Comprehensive Orthopaedics, S.c., Kenosha, WI 53142 | 2015-06-22 |
| 1669815569 | Joshua Knute Elson | Radiology | 6811 118th Ave, Kenosha, WI 53142 | 2013-04-10 |
| 1356610166 | Michael J Gallo | Pharmacist | 7535 North Greenbay Rd, Kenosha, WI 53142 | 2011-12-22 |
| 1720357999 | Orest Carnevale | Registered Nurse | 7316 155th Ct, Kenosha, WI 53142 | 2011-12-18 |
| Find all providers in zip 53142 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699031583 | Andrew Mazulis | Internal Medicine | 6308 8th Ave # 202, Kenosha, WI 53143-5031 | 2012-04-05 |
| 1447525563 | James Thomas Duncan Jr. | Internal Medicine | 515 74th St., Kenosha, WI 53143-5567 | 2012-03-22 |
| 1912928094 | Gladys Emmanuelle Hollant | Internal Medicine | 800 55th St, Kenosha, WI 53140-3733 | 2006-07-22 |
| 1013934827 | Leilane U Sta Romana | Internal Medicine | 6127 Green Bay Rd, #200, Kenosha, WI 53142-2929 | 2006-07-16 |
| 1427098722 | Giuseppe Garretto | Internal Medicine | 1020 35th St, Suite 100, Kenosha, WI 53140-1902 | 2006-06-07 |
| 1316470099 | Kristen A Chavez | Internal Medicine | 10400 75th St, Kenosha, WI 53142-7884 | 2017-04-09 |
| 1598214363 | Ihc-snf LLC | Internal Medicine | 8633 32nd Ave, Kenosha, WI 53142-5187 | 2016-09-22 |
| 1992044846 | Kelly Beth Heidle | Internal Medicine | 6308 8th Ave, Kenosha, WI 53143-5031 | 2013-02-12 |
| 1215227251 | Omar Kazmi | Internal Medicine | 10400 75th St, Kenosha, WI 53142 | 2011-04-11 |
| 1720395411 | Paul Oluwatoyin Odusanya | Internal Medicine | 6308 8th Ave, Hospitalist Management Group, United Hospitals, Kenosha, WI 53143-5031 | 2010-09-02 |
| Find all providers in KENOSHA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.