RODRIGO A MATA JR. (NPI# 1104127372) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104127372 |
| Entity Type | Individual |
| Full Name | RODRIGO A MATA JR. |
| Credential | M.D. |
| Practice Address |
6123 Green Bay Rd Suite 120 Kenosha WI 53142-2927 |
| Practice Telephone | 2626526995 |
| Practice Fax Number | 2626521370 |
| Mailing Telephone | 2626526995 |
| Mailing Fax Number | 2626521370 |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2010-11-04 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 22023-20 | WI | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033148176 | Rodrigo Buencamino Mata IIi | Internal Medicine | 6123 Green Bay Rd, Suite 120, Kenosha, WI 53142-2927 | 2006-07-01 |
| Street Address |
6123 GREEN BAY RD SUITE 120 |
| City | KENOSHA |
| State | WI |
| Zip Code | 53142-2927 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821092420 | John L Bostanche | Podiatrist | 6123 Green Bay Rd, Ste 100, Kenosha, WI 53142-2939 | 2005-06-10 |
| 1770842213 | Todd's Companionplus Inc. | In Home Supportive Care | 6123 Green Bay Rd, Suite 250, Kenosha, WI 53142-2927 | 2012-05-03 |
| 1720303332 | Chad E Sloden | Chiropractor | 6123 Green Bay Rd, Kenosha, WI 53142-2927 | 2010-04-07 |
| 1700045168 | Great Lakes Surgery Center LLC | Clinic/Center | 6123 Green Bay Rd, Suite 100, Kenosha, WI 53142-2927 | 2008-06-02 |
| 1093900136 | Great Lakes Family Medical Center Inc | Clinic/Center | 6123 Green Bay Rd, Suite 120, Kenosha, WI 53142-2927 | 2007-09-12 |
| 1295941409 | Great Lakes Foot & Ankle Centers Inc | Podiatrist | 6123 Green Bay Rd, Suite 100, Kenosha, WI 53142-2927 | 2007-05-15 |
| 1053468397 | Tarey Ann Wenninger | Physical Therapist | 6123 Green Bay Rd, Suite 140, Kenosha, WI 53142-2927 | 2007-01-05 |
| 1649291923 | Kalpana Rao | Psychologist | 6123 Green Bay Rd, Kenosha, WI 53142-2927 | 2006-07-21 |
| 1033148176 | Rodrigo Buencamino Mata IIi | Internal Medicine | 6123 Green Bay Rd, Suite 120, Kenosha, WI 53142-2927 | 2006-07-01 |
| 1801882451 | Back-in-action Physical Therapy Center of Kenosha, Ltd. | Physical Therapist | 6123 Green Bay Rd, Ste 140, Kenosha, WI 53142-2927 | 2005-09-20 |
| Find all providers in the same location | ||||
| 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 | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275003394 | Kimberly Shaffner | Family Medicine | 4536 22nd Avenue, Kenosha, WI 53140 | 2018-12-01 |
| 1770789489 | Kenosha Community Health Center, Inc | Family Medicine | 6226 14th Ave, Kenosha, WI 53143 | 2007-06-21 |
| 1578611703 | Anita I. Inveiss, M.d., S.c. | Family Medicine | 3618 8th Ave, Suite 12, Kenosha, WI 53140-2576 | 2007-01-05 |
| 1568523389 | Timothy Michael Hubbard | Family Medicine | 4400 Sheridan Rd, Kenosha, WI 53140-5747 | 2006-12-13 |
| 1417018656 | Alan Bart Cameron Sr. | Family Medicine | 5012 4th Ave, Kenosha, WI 53140-2902 | 2006-12-12 |
| 1477660744 | James M Santarelli | Family Medicine | 2707 15th Pl, Kenosha, WI 53140-4947 | 2006-08-24 |
| 1689620072 | Leonardo Montemurro Sr. | Family Medicine | 6121 Green Bay Rd Ste 100, Kenosha, WI 53142-2931 | 2006-05-26 |
| 1386608677 | Stephen P Feuerbach | Family Medicine | 5923 Green Bay Rd, Kenosha, WI 53144-3737 | 2006-04-13 |
| 1306833686 | Abdul Ghaffar Durrani | Family Medicine | 4824 Green Bay Road, Kenosha, WI 53144-1789 | 2005-10-03 |
| 1386631661 | Jawaid Quddus | Family Medicine | 6123 Green Bay Road, Suite 120, Kenosha, WI 53142-2927 | 2005-10-03 |
| 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.