Provider Demographics
NPI:1467492769
Name:RODRIGUEZ, MIGUEL H (MD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:H
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 1:6019 WALNUT GROVE RD
Mailing Address - Street 2:BAPTIST MEMPHIS MEMORIAL HOSPITAL
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2113
Mailing Address - Country:US
Mailing Address - Phone:901-226-3020
Mailing Address - Fax:
Practice Address - Street 1:6019 WALNUT GROVE RD
Practice Address - Street 2:BAPTIST MEMPHIS MEMORIAL HOSPITAL
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2113
Practice Address - Country:US
Practice Address - Phone:901-226-3020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21005207P00000X
MS13982207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3070602Medicaid
MS00116126Medicaid
TNP00294868Medicare ID - Type UnspecifiedMEDICARE RAILROAD
TNF37602Medicare UPIN
TN3070602Medicaid