Healthcare Provider Details

I. General information

NPI: 1578944989
Provider Name (Legal Business Name): ISABEL CRISTINA MENDEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W KINNICKINNIC RIVER PKWY STE 170
MILWAUKEE WI
53215
US

IV. Provider business mailing address

2801 W KINNICKINNIC RIVER PKWY STE 170
MILWAUKEE WI
53215-3678
US

V. Phone/Fax

Practice location:
  • Phone: 414-385-8600
  • Fax:
Mailing address:
  • Phone: 414-385-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125067506
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number69430
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: