MEDICARE: ENRIQUE 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	207L00000X	Anesthesiology Physician	36039513	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	36039513	OTHER	IL	MEDICAL LICENSE

General Provider Information

NPI Number	:	1801925888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENRIQUE RODRIGUEZ MD

Provider Business Mailing Address
First Line	:	PO BOX 822344
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19182-2344
Country	:	US
Telephone Number	:	314-991-0985
Fax Number	:	908-653-9305

Provider Business Practice Location Address
First Line	:	28 N 64TH ST
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62223-3808
Country	:	US
Telephone Number	:	908-653-9399
Fax Number	:	908-653-9305

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/09/2007

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