Basic Information
| Provider Information | |||||||||
| NPI: | 1972606275 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HECTOR Y RODRIGUEZ PC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ADVANCE UROLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 15138 LEVAN RD | ||||||||
| Address2: | SUITE 38 | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481545027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347792133 | ||||||||
| FaxNumber: | 7347792154 | ||||||||
| Practice Location | |||||||||
| Address1: | 15138 LEVAN RD | ||||||||
| Address2: | SUITE 38 | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481545027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347792133 | ||||||||
| FaxNumber: | 7347792154 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 01/28/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | HECTOR | ||||||||
| AuthorizedOfficialMiddleName: | Y | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7347792133 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 4301050645 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 4072034 | 01 | MI | AETNA | OTHER | P41692 | 01 | MI | BLUE CARE NETWORK | OTHER | 126783 | 01 | MI | PREFERRED CHOICES | OTHER | 340H231630 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 340018996 | 01 | MI | RAILROAD MEDICARE | OTHER | 123783 | 01 | MI | CARE CHOICES | OTHER |