Provider Demographics
NPI:1730400136
Name:RODRIGUEZ, ALEXIS MARCO (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:MARCO
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 1:973 RIVERWATCH DR
Mailing Address - Street 2:
Mailing Address - City:VILLA HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3769
Mailing Address - Country:US
Mailing Address - Phone:860-208-5169
Mailing Address - Fax:
Practice Address - Street 1:1320 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-8016
Practice Address - Country:US
Practice Address - Phone:304-793-2220
Practice Address - Fax:304-793-2277
Is Sole Proprietor?:No
Enumeration Date:2010-06-20
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48607207P00000X
MO2019020860207P00000X
OH35.127031207P00000X
390200000X
WV28433207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program