Provider Demographics
NPI:1316014566
Name:TOBAR, RODRIGO JR (DO)
Entity Type:Individual
Prefix:DR
First Name:RODRIGO
Middle Name:
Last Name:TOBAR
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:29255 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1018
Mailing Address - Country:US
Mailing Address - Phone:248-557-0535
Mailing Address - Fax:248-557-6145
Practice Address - Street 1:29255 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1018
Practice Address - Country:US
Practice Address - Phone:248-557-0535
Practice Address - Fax:248-557-6145
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIRT008998207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE26697Medicare UPIN