Provider Demographics
NPI:1073261673
Name:ROTHHORN, M CARLO
Entity Type:Individual
Prefix:
First Name:M
Middle Name:CARLO
Last Name:ROTHHORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 LEITRAM ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48915-1951
Mailing Address - Country:US
Mailing Address - Phone:517-203-8937
Mailing Address - Fax:
Practice Address - Street 1:510 N BUTLER BLVD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48915-1936
Practice Address - Country:US
Practice Address - Phone:517-894-2947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-13
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor