Provider Demographics
NPI:1831306760
Name:RODRIGUEZ, CAMILLE (DPM)
Entity type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4839
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-4839
Mailing Address - Country:US
Mailing Address - Phone:248-824-6600
Mailing Address - Fax:248-324-1477
Practice Address - Street 1:1301 W 7TH ST
Practice Address - Street 2:SUITE 121A
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-2651
Practice Address - Country:US
Practice Address - Phone:817-348-9967
Practice Address - Fax:855-298-7291
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1523213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153258201Medicaid
TX83014JMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
TX153258201Medicaid