Provider Demographics
NPI:1215933064
Name:RODRIGUEZ, MICHAEL A (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:929 GRAHAM DR
Mailing Address - Street 2:STE B
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-3338
Mailing Address - Country:US
Mailing Address - Phone:281-351-5548
Mailing Address - Fax:281-351-5020
Practice Address - Street 1:929 GRAHAM DR
Practice Address - Street 2:STE B
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-3338
Practice Address - Country:US
Practice Address - Phone:281-351-5548
Practice Address - Fax:281-351-5020
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF4439207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099237203Medicaid
TN8R1190OtherBLUE CROSS BLUE SHIELD ID
TX8B7811Medicare PIN
TX099237203Medicaid