1780628511 NPI number — DANIELA RODRIGUEZ MD PLC

Table of content: (NPI 1780628511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780628511 NPI number — DANIELA RODRIGUEZ MD PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIELA RODRIGUEZ MD PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780628511
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21727 GREATER MACK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST CLAIR SHORES
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48080-2418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-777-7260
Provider Business Mailing Address Fax Number:
586-777-7265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21727 GREATER MACK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST CLAIR SHORES
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48080-2418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-777-7260
Provider Business Practice Location Address Fax Number:
586-777-7265
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
DANIELA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
586-777-7260

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  4301080695 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 821910 . This is a "PROCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 14700 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 141579 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: H61010 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 00421 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: DE6319 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2405016902 . This is a "BCBC BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 35715 . This is a "HEALTH PLAN OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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