Provider Demographics
NPI:1104880822
Name:MESQUIDA, VERONICA (MD)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:MESQUIDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E 1ST ST
Mailing Address - Street 2:STE. 203
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2297
Mailing Address - Country:US
Mailing Address - Phone:218-249-6960
Mailing Address - Fax:218-249-6969
Practice Address - Street 1:1000 E 1ST ST
Practice Address - Street 2:STE. 203
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2297
Practice Address - Country:US
Practice Address - Phone:218-249-6960
Practice Address - Fax:218-249-6969
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN58120207RR0500X
IL036118514207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCF2064OtherRAILROAD GROUP
IL036118514OtherILLINIOS MD LICENSE
IN200466110Medicaid
IL036118514Medicaid
INP00252724OtherRAIL ROAD MEDICARE
IL753210OtherMEDICARE GROUP
INM400014671Medicare PIN
IL753210OtherMEDICARE GROUP