Provider Demographics
NPI:1841233673
Name:RODA, MICHELLE A (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:A
Last Name:RODA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7100 CAMBER LN APT 7108
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-0320
Mailing Address - Country:US
Mailing Address - Phone:312-520-4607
Mailing Address - Fax:
Practice Address - Street 1:DWIGHT D EISENHOWER ARMY MEDICAL CENTER
Practice Address - Street 2:300 E. HOSPITAL RD.
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5741
Practice Address - Country:US
Practice Address - Phone:706-787-5864
Practice Address - Fax:706-787-3999
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340107112084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F82066Medicare UPIN