Provider Demographics
NPI:1477579266
Name:RODRIGUEZ, EDWARD LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LUIS
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3500 N ELM AVE
Mailing Address - Street 2:OPMH
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-8887
Mailing Address - Country:US
Mailing Address - Phone:517-780-5254
Mailing Address - Fax:
Practice Address - Street 1:300 W WASHINGTON AVE STE 210B
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2160
Practice Address - Country:US
Practice Address - Phone:517-344-0913
Practice Address - Fax:517-905-6007
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2025-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010709592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry