Provider Demographics
NPI:1558346122
Name:ROZENCWEIG, HARRY H (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:H
Last Name:ROZENCWEIG
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 1:29992 NORTHWESTERN HWY STE C
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3292
Mailing Address - Country:US
Mailing Address - Phone:248-851-1430
Mailing Address - Fax:248-851-5182
Practice Address - Street 1:32255 NORTHWESTERN HWY STE 130A
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1566
Practice Address - Country:US
Practice Address - Phone:248-358-2310
Practice Address - Fax:248-352-0734
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301038949207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI4989028OtherMEDICARE
MI06326331OtherBCBS INDIVIDUAL
MI1558346122Medicaid
MIC1390OtherM'CARE
MI700F314390OtherBLUE SHIELD
MIC1390OtherM'CARE
MI1558346122Medicaid