MEDICARE: DR. DERCIO ARAUJO MENDONCA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	4301107790	MI
2	390200000X	Student in an Organized Health Care Education/Training Program	MT194771	PA
3	207RP1001X	Pulmonary Disease Physician	4301107790	MI

General Provider Information

NPI Number	:	1831327246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DERCIO ARAUJO MENDONCA MD

Provider Business Mailing Address
First Line	:	535 S BURDICK ST
Second Line	:	SUITE 160
City	:	KALAMAZOO
State	:	MI
Zip	:	49007-5294
Country	:	US
Telephone Number	:	269-388-5864
Fax Number	:	269-388-5211

Provider Business Practice Location Address
First Line	:	535 S BURDICK ST
Second Line	:	SUITE 160
City	:	KALAMAZOO
State	:	MI
Zip	:	49007-5294
Country	:	US
Telephone Number	:	269-388-5864
Fax Number	:	269-388-5211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2009
Last Update Date	:	11/27/2023

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