Healthcare Provider Details

I. General information

NPI: 1316975311
Provider Name (Legal Business Name): RODERICK CAIRGLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 W OUTER DR 400
DETROIT MI
48235
US

IV. Provider business mailing address

6001 W OUTER DR 400
DETROIT MI
48235
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-4200
  • Fax: 313-966-3560
Mailing address:
  • Phone: 313-966-4200
  • Fax: 313-966-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberRC059725
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: