Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | ||
Y | 222Z00000X | Podiatrist |
NPI | 1023134442 |
---|---|
Provider Name | Mr. Robert L Rhodes |
First Address | Saline, MI 48176-1178 |
Second Address | Ann Arbor, MI 48108-1318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 12/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
510H113070 | BLUE CROSS PIN (01) | MI |