Provider Demographics
NPI:1740210632
Name:MENDEZ-MULET, LUIS (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:MENDEZ-MULET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0083610207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
47943XOtherMEDICARE PTAN
FL265133500Medicaid
FL47943OtherBCBS
H71766Medicare UPIN