Provider Demographics
NPI:1356333249
Name:ROOF, RODNEY W (DPM)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:W
Last Name:ROOF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4685 FOREST AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3359
Mailing Address - Country:US
Mailing Address - Phone:513-246-7000
Mailing Address - Fax:513-246-7852
Practice Address - Street 1:8245 NORTHCREEK DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2283
Practice Address - Country:US
Practice Address - Phone:513-246-7000
Practice Address - Fax:513-246-5284
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3134213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000367060OtherANTHEM
OH4139962OtherMEDICARE
OH2145191Medicaid
OH480028277OtherRAIL ROAD MEDICARE
OH310817854026OtherCARE SOURCE
OH294797OtherAMERIGROUP
OH2145191Medicaid
OH480028277OtherRAIL ROAD MEDICARE
OH0950300001Medicare NSC