Provider Demographics
NPI:1164597662
Name:MICHAEL B ROZBORIL MD PA
Entity Type:Organization
Organization Name:MICHAEL B ROZBORIL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BOZETECH
Authorized Official - Last Name:ROZBORIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-374-9790
Mailing Address - Street 1:4741 NW 8TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-5511
Mailing Address - Country:US
Mailing Address - Phone:352-374-9790
Mailing Address - Fax:352-337-0744
Practice Address - Street 1:4741 NW 8TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-5511
Practice Address - Country:US
Practice Address - Phone:352-374-9790
Practice Address - Fax:352-337-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0046253207RR0500X
FL833592363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39598Medicare PIN