Provider Demographics
NPI:1306847504
Name:RODRIGUEZ, MIKE EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:EDWARD
Last Name:RODRIGUEZ
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 1:1521 S STAPLES ST STE 700
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3160
Mailing Address - Country:US
Mailing Address - Phone:361-888-8271
Mailing Address - Fax:361-885-3699
Practice Address - Street 1:1521 S STAPLES ST
Practice Address - Street 2:SUITE 700
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3150
Practice Address - Country:US
Practice Address - Phone:361-888-8271
Practice Address - Fax:361-885-3699
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2023-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5883207R00000X, 207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116704102Medicaid
TX860960Medicare PIN
TXF11882Medicare UPIN