Provider Demographics
NPI:1235120452
Name:ROTHSTEIN, ALAN S (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:S
Last Name:ROTHSTEIN
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 1:425 HUEHL RD UNIT 13
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2319
Mailing Address - Country:US
Mailing Address - Phone:847-504-5000
Mailing Address - Fax:844-443-0082
Practice Address - Street 1:425 HUEHL RD UNIT 13
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2319
Practice Address - Country:US
Practice Address - Phone:847-504-5000
Practice Address - Fax:844-443-0082
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000448213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL583250OtherAETNA ID (HMO)
GA000159167AMedicaid
GA144651OtherBLUE CROSS/BLUE SHIELD
FL583250OtherAETNA ID (HMO)
GA144651OtherBLUE CROSS/BLUE SHIELD
GAT97813Medicare UPIN
GA000159167AMedicaid