Provider Demographics
NPI:1427535384
Name:MICHAEL L. ROTHMAN, M.D., P.C.
Entity Type:Organization
Organization Name:MICHAEL L. ROTHMAN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-988-9783
Mailing Address - Street 1:PO BOX 22340
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-2340
Mailing Address - Country:US
Mailing Address - Phone:505-988-9783
Mailing Address - Fax:505-988-5830
Practice Address - Street 1:2945 RODEO PARK DR E UNIT 6
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6312
Practice Address - Country:US
Practice Address - Phone:505-988-9783
Practice Address - Fax:505-988-5830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM70-77207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty