Provider Demographics
NPI:1750481842
Name:RODRIGUEZ, JOSE A (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:A
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 1:27540 HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-4505
Mailing Address - Country:US
Mailing Address - Phone:586-754-6797
Mailing Address - Fax:586-754-4219
Practice Address - Street 1:27540 HOOVER RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-4505
Practice Address - Country:US
Practice Address - Phone:586-754-6797
Practice Address - Fax:586-754-4219
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044571207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200158731OtherWARREN RAD TAX ID
MI110E011830OtherSCHOENHERR BCBS GR PIN
MI1425211Medicaid
MI381898230OtherSCHOENHERR MED TAX ID
MI5696213Medicaid
MIJR044571OtherLICENSE PIN
MI700E001650OtherWARREN BCBS GROUP PIN
MI010500411OtherBCBSMI PIN
MI273901353OtherJOSE RODRIGUEZ, MD PC
MI0P48380007Medicare PIN
MIJR044571OtherLICENSE PIN
MI010500411OtherBCBSMI PIN
MI273901353OtherJOSE RODRIGUEZ, MD PC
MI5696213Medicaid