MEDICARE: WILMAR C RODRIGUEZ, M.D., PROFESSIONAL ASSOCIATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	24390	KS

General Provider Information

NPI Number	:	1164411286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILMAR C RODRIGUEZ, M.D., PROFESSIONAL ASSOCIATION

Provider Business Mailing Address
First Line	:	PO BOX 847
Second Line	:
City	:	EL DORADO
State	:	KS
Zip	:	67042-0847
Country	:	US
Telephone Number	:	316-321-7683
Fax Number	:	316-322-7750

Provider Business Practice Location Address
First Line	:	700 W CENTRAL AVE
Second Line	:	SUITE 106
City	:	EL DORADO
State	:	KS
Zip	:	67042-2184
Country	:	US
Telephone Number	:	316-321-7683
Fax Number	:	316-322-7750

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILMAR RODRIGUEZ
Credential	:	M.D.
Telephone Number	:	316-321-7683

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	08/22/2020

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