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1104127372
RODRIGO A MATA
KENOSHA, WI
NPI
1104127372
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
207Q00000X Family Medicine
(Licence: WI 22023-20)
Enumeration Date
2010-11-04
Last Update Date
2010-11-04
Business Address
RODRIGO A MATA M.D.
6123 GREEN BAY RD SUITE 120
KENOSHA, WI 53142-2927
Phone number: 262-652-6995
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Mailing Address
RODRIGO A MATA M.D.
6123 GREEN BAY RD SUITE 120
KENOSHA, WI 53142-2927
Phone number: 262-652-6995
Copy
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