Provider Demographics
NPI:1790709996
Name:RODRIGUEZ, PAUL NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:NICHOLAS
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:245 CHERRY ST SE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4607
Mailing Address - Country:US
Mailing Address - Phone:616-459-3551
Mailing Address - Fax:616-459-1060
Practice Address - Street 1:245 CHERRY ST SE
Practice Address - Street 2:SUITE 202
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4607
Practice Address - Country:US
Practice Address - Phone:616-459-3551
Practice Address - Fax:616-459-1060
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIPR051567208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1852121Medicaid
MI1852121Medicaid
MIB56114Medicare UPIN