Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Tyson Roderique, DO

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1487406815

Tyson Roderique, DO is a Student in an Organized Health Care Education/Training Program in Clinton Twp, Michigan. Registered with an NPI since 2024.

In the registry since
2024
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

15855 19 Mile Rd
Clinton Twp, MI 48038-3504
Phone: (586) 263-2300
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1487406815
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedApril 1, 2024
Last updated in NPPESApril 1, 2024
Certification dateApril 1, 2024
Mailing address15855 19 Mile Rd, Clinton Twp, MI 48038-3504

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