Provider Demographics
NPI:1780628511
Name:DANIELA RODRIGUEZ MD PLC
Entity Type:Organization
Organization Name:DANIELA RODRIGUEZ MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-777-7260
Mailing Address - Street 1:21727 GREATER MACK AVE
Mailing Address - Street 2:
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2418
Mailing Address - Country:US
Mailing Address - Phone:586-777-7260
Mailing Address - Fax:586-777-7265
Practice Address - Street 1:21727 GREATER MACK AVE
Practice Address - Street 2:
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2418
Practice Address - Country:US
Practice Address - Phone:586-777-7260
Practice Address - Fax:586-777-7265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080695208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI821910OtherPROCARE
MI14700OtherMCARE
MI141579OtherCARE CHOICES
MIH61010OtherHAP
MI00421OtherAETNA
MIDE6319OtherRAILROAD MEDICARE
MI2405016902OtherBCBC BCN
MI35715OtherHEALTH PLAN OF MI
MI141579OtherCARE CHOICES
MI14700OtherMCARE