Healthcare Provider Details

I. General information

NPI: 1528356284
Provider Name (Legal Business Name): MICHAEL RODRIGUEZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20325 N 51ST AVE STE 154
GLENDALE AZ
85308-4622
US

IV. Provider business mailing address

20325 N 51ST AVE STE 154
GLENDALE AZ
85308-4622
US

V. Phone/Fax

Practice location:
  • Phone: 623-900-4740
  • Fax: 855-398-9290
Mailing address:
  • Phone: 623-900-4740
  • Fax: 855-398-9290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number006885
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: