Provider Demographics
NPI:1710197835
Name:DIAZ-MENDOZA, JAVIER IVAN (MD)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:IVAN
Last Name:DIAZ-MENDOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAVIER
Other - Middle Name:IVAN
Other - Last Name:DIAZ MENDOZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2799 WEST GRAND BOULEVARD
Mailing Address - Street 2:HENRY FORD HEALTH SYSTEM
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202
Mailing Address - Country:US
Mailing Address - Phone:313-916-2421
Mailing Address - Fax:313-916-9102
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-2421
Practice Address - Fax:313-916-9102
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081549207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease