Provider Demographics
NPI:1154390300
Name:MENENDEZ, CARLOS K (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:K
Last Name:MENENDEZ
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 1:5735 MEEKER RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331
Mailing Address - Country:US
Mailing Address - Phone:937-548-3806
Mailing Address - Fax:937-548-2087
Practice Address - Street 1:5735 MEEKER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331
Practice Address - Country:US
Practice Address - Phone:937-548-3806
Practice Address - Fax:937-548-2087
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050800M207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0630295Medicaid
OH0630295Medicaid
OHME0592082Medicare ID - Type Unspecified