Provider Demographics
NPI:1477539419
Name:ROTSTEIN, MICHAEL H (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:ROTSTEIN
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 1:2135 SW 19TH AVENUE RD
Mailing Address - Street 2:SUITE #104
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-0000
Mailing Address - Country:US
Mailing Address - Phone:352-867-1155
Mailing Address - Fax:352-867-7030
Practice Address - Street 1:2135 SW 19TH AVENUE RD
Practice Address - Street 2:SUITE #104
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7874
Practice Address - Country:US
Practice Address - Phone:352-867-1155
Practice Address - Fax:352-867-7030
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0002144213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL480011745OtherRR MEDICARE ID
FL65157Medicare PIN
FL480011745OtherRR MEDICARE ID