Provider Demographics
NPI:1346479920
Name:MAZE-ROTHSTEIN, GALEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GALEN
Middle Name:
Last Name:MAZE-ROTHSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 AVIS DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-9649
Mailing Address - Country:US
Mailing Address - Phone:734-213-3931
Mailing Address - Fax:734-926-0090
Practice Address - Street 1:3544 NW ASTOR ST
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-8580
Practice Address - Country:US
Practice Address - Phone:734-213-3931
Practice Address - Fax:734-926-0090
Is Sole Proprietor?:No
Enumeration Date:2009-07-05
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN140902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology