Provider Demographics
NPI:1174634166
Name:ROSENTHAL, HILARY ANN (DPM)
Entity Type:Individual
Prefix:DR
First Name:HILARY
Middle Name:ANN
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5755 W MAPLE RD
Mailing Address - Street 2:STE 115
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4415
Mailing Address - Country:US
Mailing Address - Phone:248-626-7180
Mailing Address - Fax:248-626-7175
Practice Address - Street 1:5755 W MAPLE RD
Practice Address - Street 2:STE 115
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4415
Practice Address - Country:US
Practice Address - Phone:248-626-7180
Practice Address - Fax:248-626-7175
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001598213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4338880OtherUNITED HEALTH CARE
MIHR001598OtherBLUE CROSS BLUE SHIELD
MIU42602OtherHAP
0828050001OtherADMINISTAR DMERC
480019108OtherRAILROAD MEDICARE
MI3298010Medicaid
4338880OtherAETNA
MI16130OtherGREAT LAKES HEALTH PLAN
MI3298010Medicaid
MI0F37115003Medicare PIN
MIHR001598OtherBLUE CROSS BLUE SHIELD