MEDICARE: MARCO ANTONIO RODRIGUEZ M.D.

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	207P00000X	Emergency Medicine Physician	036129307	IL

General Provider Information

NPI Number	:	1669615241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCO ANTONIO RODRIGUEZ M.D.

Provider Business Mailing Address
First Line	:	11406 AUTUMN RIDGE DR
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60467-1343
Country	:	US
Telephone Number	:	708-691-2656
Fax Number	:

Provider Business Practice Location Address
First Line	:	5665 NEW NORTHSIDE DR
Second Line	:	#320
City	:	ATLANTA
State	:	GA
Zip	:	30328-5834
Country	:	US
Telephone Number	:	770-874-5400
Fax Number	:

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

Provider Enumeration Date	:	04/13/2009
Last Update Date	:	09/11/2012

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Directions to “ MARCO ANTONIO RODRIGUEZ M.D.” Practice Location

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