Provider Demographics
NPI:1992754402
Name:RODEN, DAVID MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:RODEN
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 1:4310 N CAMPUS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6104
Mailing Address - Country:US
Mailing Address - Phone:989-839-6201
Mailing Address - Fax:989-839-6202
Practice Address - Street 1:4310 N CAMPUS RIDGE DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6104
Practice Address - Country:US
Practice Address - Phone:989-839-6201
Practice Address - Fax:989-839-6202
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDR066147207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI040E610050OtherBCBS/BCN
MI0M11400002OtherMEDICARE RAILROAD
MI3157773Medicaid
MI3157773Medicaid
MI040E610050OtherBCBS/BCN