Individual
DR. HEIDI ENEJOSA RODILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
901 W GREENWOOD ST STE 1, ABBEVILLE, SC 29620-5727
(864) 366-9681
(864) 366-5600
Mailing address
PO BOX 968, ABBEVILLE, SC 29620-0968
(864) 366-9681
(864) 366-5600
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
11698
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080085988
MEDICARE RAILROAD
SC
01
—
11698
SC LICENSE NUMBER
SC
05
—
116984
—
SC
01
—
582366449
TAX ID
—
05
—
PC3126
—
SC
05
—
RHC210
—
SC
Enumeration date
11/28/2006
Last updated
01/06/2023
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