Healthcare Provider Details

I. General information

NPI: 1417874249
Provider Name (Legal Business Name): MICHAEL L RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 GREEN RIDGE DR
WICKLIFFE OH
44092-2010
US

IV. Provider business mailing address

2195 GREEN RIDGE DR
WICKLIFFE OH
44092-2010
US

V. Phone/Fax

Practice location:
  • Phone: 440-622-9049
  • Fax:
Mailing address:
  • Phone: 440-622-9049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: