Provider Demographics
NPI:1851167159
Name:CHRISTOPHER J. MESA, M.D., PLLC
Entity Type:Organization
Organization Name:CHRISTOPHER J. MESA, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR /OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JORGE
Authorized Official - Last Name:MESA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-510-7345
Mailing Address - Street 1:2510 SW 27TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2164
Mailing Address - Country:US
Mailing Address - Phone:786-703-7000
Mailing Address - Fax:786-703-7777
Practice Address - Street 1:2510 SW 27TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2164
Practice Address - Country:US
Practice Address - Phone:786-703-7000
Practice Address - Fax:786-703-7777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2464400Medicaid
FLME149611OtherMEDICAL LICENSES