Provider Demographics
NPI:1255325684
Name:CLAYBROOKS, RODERICK (MD)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:
Last Name:CLAYBROOKS
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 1:22250 PROVIDENCE DR
Mailing Address - Street 2:SUITE 601
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4825
Mailing Address - Country:US
Mailing Address - Phone:248-569-7745
Mailing Address - Fax:248-569-4539
Practice Address - Street 1:22250 PROVIDENCE DR
Practice Address - Street 2:SUITE 601
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4825
Practice Address - Country:US
Practice Address - Phone:248-569-7745
Practice Address - Fax:248-569-4539
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074231207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4781570Medicaid
MI7542611OtherAETNA
MI12897OtherCAPE
MI141817OtherCARE CHOICES
MIP00271654OtherRDMC
MI17348OtherMCARE
MIRC074231OtherBCBS
MI024520OtherMIDWEST
MI59938OtherOMNICARE
MI630511OtherBLUE CROSS NETWORK
MITAX I.D.Other20-0440211
MI607926000OtherOCWP
MI150941OtherGREAT LAKES