Healthcare Provider Details

I. General information

NPI: 1114887486
Provider Name (Legal Business Name): MR. CHRISTOPHER JOSEPH RHODES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33155 ANNAPOLIS ST
WAYNE MI
48184-2405
US

IV. Provider business mailing address

8785 BROOKE PARK DR APT 103
CANTON MI
48187-4039
US

V. Phone/Fax

Practice location:
  • Phone: 734-467-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number4703128779
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: