Provider Demographics
NPI:1174581821
Name:RODRIGUEZ, ALEXANDER JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:JOSE
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2313 E HILL RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-5059
Practice Address - Country:US
Practice Address - Phone:810-953-6400
Practice Address - Fax:810-953-6477
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0999968OtherHEALTH PLUS
MI7133659OtherAETNA
MI080251192OtherBLUE CROSS INDIVIDUAL
MI080B513530OtherBLUE CARE NETWORK
MI1015328OtherMCLAREN HEALTH PLAN
MI1015328OtherHEALTH ADVANTAGE NETWORK
MII16772OtherHEALTH ALLIANCE PLAN
MI080B513530OtherBLUE CROSS BLUE SHIELD GR
MI4743550Medicaid
MII16772OtherHEALTH ALLIANCE PLAN
MI4743550Medicaid