Provider Demographics
NPI:1255426102
Name:MENDOZA, HENRY P (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:P
Last Name:MENDOZA
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 1:2239 S LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5412
Mailing Address - Country:US
Mailing Address - Phone:810-732-0020
Mailing Address - Fax:810-732-7937
Practice Address - Street 1:2239 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5412
Practice Address - Country:US
Practice Address - Phone:810-732-0020
Practice Address - Fax:810-732-7937
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301031986207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1015680Medicaid
MI0258594OtherBLUE CROSS BLUE SHIELD
MI1015680Medicaid
MI0258594OtherBLUE CROSS BLUE SHIELD