Provider Demographics
NPI:1003800673
Name:ROSENTHAL, MICHAEL R (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8210 WALNUT HILL LN
Mailing Address - Street 2:#619
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231
Mailing Address - Country:US
Mailing Address - Phone:214-345-5630
Mailing Address - Fax:214-345-5632
Practice Address - Street 1:8210 WALNUT HILL LN
Practice Address - Street 2:#619
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:214-345-5630
Practice Address - Fax:214-345-5632
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD84162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCB91Medicare ID - Type Unspecified
C21321Medicare UPIN