Provider Demographics
NPI:1215034517
Name:MITCHELL S ROTHSTEIN M D INC
Entity Type:Organization
Organization Name:MITCHELL S ROTHSTEIN M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROTHSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-366-3738
Mailing Address - Street 1:PO BOX 380009
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-0509
Mailing Address - Country:US
Mailing Address - Phone:904-388-3357
Mailing Address - Fax:904-384-5746
Practice Address - Street 1:425 N LEE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-1127
Practice Address - Country:US
Practice Address - Phone:904-388-3357
Practice Address - Fax:904-384-5746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 50862207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3023Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER