Provider Demographics
NPI:1851672166
Name:RHOADES, JUAN
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:RHOADES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 WALTON BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1768
Mailing Address - Country:US
Mailing Address - Phone:248-650-1800
Mailing Address - Fax:248-650-1856
Practice Address - Street 1:1460 WALTON BLVD
Practice Address - Street 2:STE 200
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1768
Practice Address - Country:US
Practice Address - Phone:248-650-1800
Practice Address - Fax:248-650-1856
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704249481363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner