NPI Code Detail JSON Logo

1629020342 NPI number — JOSE MENDEZ MD

NPI Number: 1629020342
Health Care Provider/Practitioner: JOSE MENDEZ MD

Information about “1629020342” NPI (JOSE MENDEZ MD) exists in 1629020342 in HTML format HTML  |  1629020342 in plain Text format TXT  |  1629020342 in PDF (Portable Document Format) PDF  |  1629020342 in an XML format XML  formats.

NPI Number : 1629020342 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629020342",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MENDEZ",
    "FirstName": "JOSE",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MENDEZ",
    "OtherFirstName": "JOE",
    "OtherMiddleName": null,
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "M.D.",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "26901 BEAUMONT BLVD STE 3D",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SOUTHFIELD",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48033-3849",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "17000 HUBBARD DR STE 800",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DEARBORN",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48126-4205",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "313-240-7595",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/17/2006",
    "LastUpdateDate": "01/15/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "208100000X",
        "TaxonomyName": "Physical Medicine & Rehabilitation Physician",
        "LicenseNumber": "4301103728",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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