Basic Information
Provider Information
NPI: 1003154097
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RHODES
FirstName: ALFRED
MiddleName: KEITH
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10735 STONE CREEK LN
Address2:  
City: AURORA
State: IN
PostalCode: 470017782
CountryCode: US
TelephoneNumber: 8129269342
FaxNumber:  
Practice Location
Address1: 10735 STONE CREEK LN
Address2:  
City: AURORA
State: IN
PostalCode: 470017782
CountryCode: US
TelephoneNumber: 8129269342
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/25/2013
LastUpdateDate: 01/25/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X01019657AINY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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