Provider Demographics
NPI:1598793499
Name:MIGUEL, RODNEY M (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:M
Last Name:MIGUEL
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:6420 DUTCHMANS PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3372
Practice Address - Country:US
Practice Address - Phone:502-891-8300
Practice Address - Fax:502-891-8338
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32295207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1141335OtherPASSPORT PIN
KY2438117000OtherPASSPORT ADVANTAGE PIN
KYP00992191OtherRAILROAD MEDICARE
IN200392420FMedicaid
IN200392420AMedicaid
KY64030828Medicaid
KY000000197258OtherANTHEM PIN
KY0558510Medicare ID - Type Unspecified
KY1271836Medicare ID - Type Unspecified
KY0713004Medicare ID - Type Unspecified
KY000000197258OtherANTHEM PIN
KY1141335OtherPASSPORT PIN
IN200392420FMedicaid
KYP00992191OtherRAILROAD MEDICARE
KY060063645Medicare PIN
KYH34033Medicare UPIN
KY0368209Medicare ID - Type Unspecified
KYP400031689Medicare PIN
KY00059010Medicare PIN