Provider Demographics
NPI:1689638629
Name:RODICIO, ILEANA M (MD)
Entity type:Individual
Prefix:DR
First Name:ILEANA
Middle Name:M
Last Name:RODICIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11880 SW 40TH ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3584
Mailing Address - Country:US
Mailing Address - Phone:305-223-8808
Mailing Address - Fax:305-223-8974
Practice Address - Street 1:9000 SW 137TH AVE
Practice Address - Street 2:SUITE 213
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1411
Practice Address - Country:US
Practice Address - Phone:305-388-0078
Practice Address - Fax:305-388-2029
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME88103207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1340ZOtherMEDICARE
FL267769500Medicaid
FL267769500Medicaid