Individual
RODERICK CLAYBROOKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
22250 PROVIDENCE DR, SUITE 601, SOUTHFIELD, MI 48075-4825
(248) 569-7745
(248) 569-4539
Mailing address
22250 PROVIDENCE DR, SUITE 601, SOUTHFIELD, MI 48075-4825
(248) 569-7745
(248) 569-4539
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
4301074231
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024520
MIDWEST
MI
01
—
12897
CAPE
MI
01
—
141817
CARE CHOICES
MI
01
—
150941
GREAT LAKES
MI
01
—
17348
MCARE
MI
05
—
4781570
—
MI
01
—
59938
OMNICARE
MI
01
—
607926000
OCWP
MI
01
—
630511
BLUE CROSS NETWORK
MI
01
—
7542611
AETNA
MI
01
—
P00271654
RDMC
MI
01
—
RC074231
BCBS
MI
01
—
TAX I.D.
20-0440211
MI
Enumeration date
08/31/2005
Last updated
07/08/2007
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