Provider Demographics
NPI:1922396142
Name:RODRIGUEZ, KEITH (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 E 9TH ST APT 2204
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-4505
Mailing Address - Country:US
Mailing Address - Phone:512-557-2066
Mailing Address - Fax:
Practice Address - Street 1:5840 S MARYLAND AVE
Practice Address - Street 2:MC4028
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1462
Practice Address - Country:US
Practice Address - Phone:773-702-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.059014207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology