Healthcare Provider Details

I. General information

NPI: 1477238251
Provider Name (Legal Business Name): ELISA MARIA ROSARIO RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23050 WEST RD STE 260
BROWNSTOWN TWP MI
48183-1473
US

IV. Provider business mailing address

50 N PERRY ST
PONTIAC MI
48342-2217
US

V. Phone/Fax

Practice location:
  • Phone: 734-671-1867
  • Fax:
Mailing address:
  • Phone: 248-338-5392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301513525
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: