| Doctor Name: | MICHAEL RODRIGUEZ |
| NPI Number: | 1801243365 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 1 W Main St Fleetwood, PA - 195221323 |
| Business Phone Number: | 6109440445 |
| Business Fax Number: | 6109448834 |
| Mailing Address: | 1 W Main St, FLEETWOOD |
| State: | PA |
| Postal Code: | 195221323 |
| Phone Number: | 6109440445 |
| Fax Number: | 6109448834 |
| NPI Enumeration Date: | 05/15/2016 |
| NPI Last Update Date: | 05/15/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1102X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Military Outpatient Operational (Transportable) Component |
| Taxonomy Definition: | |