Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 4351045117 | MI |
NPI | 1003474578 |
---|---|
Provider Name | Dr. Daniel Steven Edwin Rode |
First Address | Burton, MI 48509-1429 |
Second Address | Burton, MI 48509-1429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2019 |
Last Update Date | 30/05/2019 |