Provider Demographics
NPI:1033446984
Name:HSU, EILEEN RODRIGUEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:RODRIGUEZ
Last Name:HSU
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 1:740 N STATE ROAD 25
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46975-9785
Mailing Address - Country:US
Mailing Address - Phone:574-223-6080
Mailing Address - Fax:
Practice Address - Street 1:740 N STATE ROAD 25
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46975-9785
Practice Address - Country:US
Practice Address - Phone:574-223-6080
Practice Address - Fax:574-224-6080
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040079A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100335850AMedicaid