Provider Demographics
NPI:1760580500
Name:MENDIOLA, ROLANDO M (MD)
Entity Type:Individual
Prefix:
First Name:ROLANDO
Middle Name:M
Last Name:MENDIOLA
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 1:2745 W LAYTON AVENUE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2265
Mailing Address - Country:US
Mailing Address - Phone:414-281-7883
Mailing Address - Fax:414-281-2878
Practice Address - Street 1:2745 W LAYTON AVENUE
Practice Address - Street 2:SUITE 202
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-2265
Practice Address - Country:US
Practice Address - Phone:414-281-7883
Practice Address - Fax:414-281-2878
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22461208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30252800Medicaid
WI01173Medicare ID - Type Unspecified
WI30252800Medicaid