Provider Demographics
NPI:1497732879
Name:RODRICKS, MICHAEL B (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:RODRICKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:285 DAVIDSON AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-4153
Mailing Address - Country:US
Mailing Address - Phone:732-271-1400
Mailing Address - Fax:732-271-3544
Practice Address - Street 1:285 DAVIDSON AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-4153
Practice Address - Country:US
Practice Address - Phone:732-271-1400
Practice Address - Fax:732-271-3544
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81398207L00000X, 207LC0200X
NJ25MA07126600207L00000X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260314400Medicaid
FL51894OtherBCBS
FLH25593Medicare UPIN
FL51894OtherBCBS