Healthcare Provider Details

I. General information

NPI: 1144726324
Provider Name (Legal Business Name): ANJEANETTE MENDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 W WATERTOWN PLANK RD
MILWAUKEE WI
53226-3548
US

IV. Provider business mailing address

1808 W BELTLINE HWY
MADISON WI
53713-2334
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-4575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number72944-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: