MEDICARE: NISIS MARIE RODRIGUEZ MD

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	207Q00000X	Family Medicine Physician	18416	PR
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	35.131606	OH
3	207QG0300X	Geriatric Medicine (Family Medicine) Physician	18416	PR
4	207Q00000X	Family Medicine Physician	ME159275	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457500258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NISIS MARIE RODRIGUEZ MD

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:	305-500-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	17160 ROYAL PALM BLVD STE 2
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-2395
Country	:	US
Telephone Number	:	954-762-6440
Fax Number	:	800-618-2120

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	01/19/2024

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