Individual
JAIME RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6701 PAW PAW AVE, COLOMA, MI 49038-9519
(269) 468-6430
Mailing address
54581 CALIFORNIA RD, DOWAGIAC, MI 49047-9237
(269) 782-1690
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301059475
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104226795
—
MI
05
—
104264141
—
MI
01
—
35-0-14-4904-2
BCBSM
MI
01
—
700A460030
BCBSM - GROUP
MI
Enumeration date
08/22/2005
Last updated
01/20/2012
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