Provider Demographics
NPI:1013965482
Name:MENDEZ, JOSE CUITLAHUAC (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:CUITLAHUAC
Last Name:MENDEZ
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 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-6000
Mailing Address - Fax:414-805-6280
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-6000
Practice Address - Fax:414-805-6280
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47402207RC0000X, 207RC0200X, 207RA0001X, 207RC0000X
NMMD2019-1021207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX340097002Medicaid
TX340097003Medicaid
TX340097001Medicaid
WI34585700Medicaid
WIE18632Medicare UPIN
TX340097003Medicaid
WI34585700Medicaid
TX340097002Medicaid
TX366782YKY6Medicare PIN