Rodrigo A Mata Jr., M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

22023-20 Issued in WI

Practice address

6123 Green Bay Rd
Suite 120
Kenosha, WI 53142-2927

Phone

(262) 652-6995

Fax

(262) 652-1370

NPI assigned

Nov 4, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789257600000",
    "number": "1104127372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6123 GREEN BAY RD",
            "address_2": "SUITE 120",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422927",
            "telephone_number": "262-652-6995",
            "fax_number": "262-652-1370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6123 GREEN BAY RD",
            "address_2": "SUITE 120",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422927",
            "telephone_number": "262-652-6995",
            "fax_number": "262-652-1370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATA",
        "first_name": "RODRIGO",
        "middle_name": "A",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-11-04",
        "last_updated": "2026-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "22023-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David T Marx, PSY.D.
• Autumn Marzette-Anderson, LPC
• Molly Mason, CRNA
• Ann Mastrostefano, COTA
• Nicholas Masyga
• Rodrigo Buencamino Mata III, M.D.
• Heather Nicole Matejka, DMD
• Mathew McCarthy, MD, SC
• Mithin Mathew, DO
• Anitha Mathews, RPH

• Family Medicine Physician in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.