Provider Demographics
NPI:1649200536
Name:LUIS MENDEZ-MULET MD PA
Entity Type:Organization
Organization Name:LUIS MENDEZ-MULET MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ-MULET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-271-1919
Mailing Address - Street 1:PO BOX 561023
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33256-1023
Mailing Address - Country:US
Mailing Address - Phone:305-271-1919
Mailing Address - Fax:305-271-1911
Practice Address - Street 1:9240 SW 72ND ST STE 241
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3265
Practice Address - Country:US
Practice Address - Phone:305-271-1905
Practice Address - Fax:305-271-1911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0083610207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265133500Medicaid
FLAI586OtherMEDICARE PTAN
FL47943OtherBCBS
FL265133500Medicaid