Healthcare Provider Details

I. General information

NPI: 1386716595
Provider Name (Legal Business Name): MICHAEL GENE RHODE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 5210 BOX 230
APO AE
09461-5210
US

IV. Provider business mailing address

UNIT 5210 BOX 230
APO AE
09461-5210
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-8834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License NumberS6496
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number35174-20
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number35174-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: