Provider Demographics
NPI:1932831591
Name:RODRIGUEZ TIRADO, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:RODRIGUEZ TIRADO
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:URB. VILLAS DE LAS PRADERAS
Mailing Address - Street 2:CALLE LAS GAVIOTAS, CASA #54
Mailing Address - City:RINCON
Mailing Address - State:PR
Mailing Address - Zip Code:00677
Mailing Address - Country:US
Mailing Address - Phone:939-339-2976
Mailing Address - Fax:
Practice Address - Street 1:CARR 115 KM 24.5
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-589-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23371208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice