Provider Demographics
NPI:1548276082
Name:RODRIGUEZ, MARCOS A (MD)
Entity type:Individual
Prefix:
First Name:MARCOS
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1131 N OSSEO RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-9714
Mailing Address - Country:US
Mailing Address - Phone:517-523-3695
Mailing Address - Fax:517-523-3311
Practice Address - Street 1:200 ORLEANS BLVD STE C
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1768
Practice Address - Country:US
Practice Address - Phone:517-279-0400
Practice Address - Fax:517-278-8901
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMR087022207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4833907Medicaid
MI1101210242OtherBCBSM
MI1101210242OtherBCBSM
MIP27530001Medicare PIN
MI4833907Medicaid
MI0P27530Medicare ID - Type Unspecified