Healthcare Provider Details

I. General information

NPI: 1164359485
Provider Name (Legal Business Name): MELISSA RODRIGUEZ MENDOZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA RODRIGUEZ MD

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1969 W OGDEN AVE
CHICAGO IL
60612-3773
US

IV. Provider business mailing address

1950 W POLK ST STE 5210
CHICAGO IL
60612-3723
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125087520
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: