Provider Demographics
NPI:1114919230
Name:ROTHSCHILD, CHESLOVAS (MD PHD FACS)
Entity Type:Individual
Prefix:
First Name:CHESLOVAS
Middle Name:
Last Name:ROTHSCHILD
Suffix:
Gender:M
Credentials:MD PHD FACS
Other - Prefix:DR
Other - First Name:CESLOVAS
Other - Middle Name:
Other - Last Name:VAICYS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1887 KINGSLEY AVE
Mailing Address - Street 2:SUITE1900
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4416
Mailing Address - Country:US
Mailing Address - Phone:904-276-7336
Mailing Address - Fax:904-276-7337
Practice Address - Street 1:1887 KINGSLEY AVE
Practice Address - Street 2:SUITE1900
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4416
Practice Address - Country:US
Practice Address - Phone:904-276-7336
Practice Address - Fax:904-276-7337
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064527207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1114919230Medicaid
FL005530600Medicaid
FL35456UMedicare PIN
MI1114919230Medicaid