MEDICARE: DR. DANIELA MARIA RODRIGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	4301080695	MI

General Provider Information

NPI Number	:	1215939673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIELA MARIA RODRIGUEZ

Provider Business Mailing Address
First Line	:	21727 MACK AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-2418
Country	:	US
Telephone Number	:	586-777-7260
Fax Number	:	586-777-7265

Provider Business Practice Location Address
First Line	:	21727 MACK AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-2418
Country	:	US
Telephone Number	:	586-777-7260
Fax Number	:	586-777-7265

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	11/23/2009

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