Provider Demographics
NPI:1184343535
Name:RODRIGUEZ, MANUEL ANDREW
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:ANDREW
Last Name:RODRIGUEZ
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 1:1002 S HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-1648
Mailing Address - Country:US
Mailing Address - Phone:989-501-3117
Mailing Address - Fax:
Practice Address - Street 1:504 N GRAND TRAVERSE ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2536
Practice Address - Country:US
Practice Address - Phone:586-491-1057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist