1. Home
  2. Directory
  3. Michigan
  4. Clinton Twp
  5. Student In An Organized Health Care Education Training Program
  6. NPI Profile

TYSON RODERIQUE DO
NPI 1487406815
Student in an Organized Health Care Education/Training Program in Clinton Twp, MI

Active since April 01, 2024PECOS Enrolled
15855 19 MILE RD, CLINTON TWP, MI 48038(586) 263-2300 Get Directions Write a Review

NPPES record last updated: April 1, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Tyson Roderique Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TYSON RODERIQUE DO (NPI 1487406815) is an individual student in an organized health care education/training program in Clinton Twp, Michigan and active in the NPI registry since April 2024. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1487406815
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameTYSON RODERIQUECredential: DO
Location Address15855 19 MILE RDClinton Twp, MI 48038-3504
Mailing Address15855 19 Mile RdClinton Twp, MI 48038-3504
Phone(586) 263-2300
Sole ProprietorNo
Enumeration DateApril 1, 2024
NPPES CertifiedApril 1, 2024
✔ NPI 1487406815 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
15855 19 MILE RD, Clinton Twp, MI 48038
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Tyson Roderique Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. LEEANN WICKENS P.A.
Physician Assistant
15855 19 MILE RD
CLINTON TWP, MI 48038
Macomb County (586) 203-1940
CYNTHIA GEE D.O.
Emergency Medicine
15855 19 MILE RD
CLINTON TOWNSHIP, MI 48038
Macomb County (701) 340-2053
SARAH E NELSON
Nurse Practitioner (Adult Health)
15855 19 MILE RD
CLINTON TOWNSHIP, MI 48038
Macomb County (313) 623-7602
MS. KARA NICOLE SZCZOMAK PA-C
Physician Assistant
15855 19 MILE RD
CLINTON TOWNSHIP, MI 48038
Macomb County (586) 263-2601
EMILY SOPEL
Occupational Therapist
15855 19 MILE RD
CLINTON TWP, MI 48038
Macomb County (586) 263-2300
ANTONIO MACERI MD
Student in an Organized Health Care Education/Training Program
15855 19 MILE RD
CLINTON TOWNSHIP, MI 48038
Macomb County (586) 263-2300
HENRY FORD MACOMB HOSPITAL CORPORATION
General Acute Care Hospital
15855 19 MILE RD
CLINTON TWP, MI 48038
Macomb County (568) 263-2705
JEFFREY A BERG CRNA
Nurse Anesthetist, Certified Registered
15855 19 MILE RD
CLINTON TWP, MI 48038
Macomb County (586) 263-2370

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tyson Roderique's NPI number?

The NPI number for Tyson Roderique is 1487406815. It was assigned to this individual provider in the NPPES registry on April 1, 2024.

Where is Tyson Roderique located?

Tyson Roderique practices at 15855 19 Mile Rd, Clinton Twp, MI 48038. The listed phone number is (586) 263-2300.

What is Tyson Roderique's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Tyson Roderique enrolled in Medicare?

Yes. Tyson Roderique is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Tyson Roderique was last updated on April 1, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.