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NPI Code Detail

MEDICARE: DR. SERGIO H RODRIGUEZ M.D.

MEDICARE: DR. SERGIO H RODRIGUEZ M.D.
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
1207R00000XInternal Medicine Physician036081711IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1F400229181OTHERILMEDICARE PTAN

General Provider Information

NPI Number : 1588705230
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SERGIO H RODRIGUEZ M.D.
Provider Business Mailing Address
First Line : PO BOX 746715
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6715
Country : US
Telephone Number : 773-242-2370
Fax Number : 773-249-1250
Provider Business Practice Location Address
First Line : 4327 S ARCHER AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60632-2844
Country : US
Telephone Number : 773-242-2370
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2007
Last Update Date : 09/16/2025

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