Provider Demographics
NPI:1861477432
Name:RODNER, HAROLD HD (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:HD
Last Name:RODNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:28625 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 213
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1834
Mailing Address - Country:US
Mailing Address - Phone:248-354-9666
Mailing Address - Fax:248-354-3653
Practice Address - Street 1:28625 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 243
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1834
Practice Address - Country:US
Practice Address - Phone:248-354-9666
Practice Address - Fax:248-354-3653
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301026387207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0636619OtherBCBS INDIVIDUAL
MIC1395OtherM'CARE
MI700F314390OtherBLUE SHIELD
MI1861477432Medicaid
MI0636619OtherBCBS INDIVIDUAL
MIC1395OtherM'CARE