Provider Demographics
NPI:1629019849
Name:RODRIGUEZ, JAMES RONALD (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RONALD
Last Name:RODRIGUEZ
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 1:6 TIGER CT
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-2052
Mailing Address - Country:US
Mailing Address - Phone:630-364-1917
Mailing Address - Fax:
Practice Address - Street 1:6 TIGER CT
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-2052
Practice Address - Country:US
Practice Address - Phone:630-364-1917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU72631Medicare UPIN
ILL66718Medicare ID - Type UnspecifiedMEDICARE NUMBER