Provider Demographics
NPI:1093713265
Name:ROSENTHALL, EUGENE MARK (DPM)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:MARK
Last Name:ROSENTHALL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 E 9TH AVE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3900
Mailing Address - Country:US
Mailing Address - Phone:303-333-6556
Mailing Address - Fax:303-333-2593
Practice Address - Street 1:4500 E 9TH AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3900
Practice Address - Country:US
Practice Address - Phone:303-333-6556
Practice Address - Fax:303-333-2593
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO644213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO15278379Medicaid
CO5160120001Medicare NSC
COC530298Medicare ID - Type Unspecified
CO15278379Medicaid