Healthcare Provider Details

I. General information

NPI: 1205815529
Provider Name (Legal Business Name): MIGUEL DE JESUS RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8525 SW 92ND ST SUITE C-10
MIAMI FL
33156-7378
US

IV. Provider business mailing address

8525 SW 92ND STREET SUITE C-10
MIAMI FL
33156-7378
US

V. Phone/Fax

Practice location:
  • Phone: 305-274-7800
  • Fax: 305-270-1246
Mailing address:
  • Phone: 305-274-7800
  • Fax: 305-270-1246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME68746
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME68746
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: