Provider Demographics
NPI:1568899896
Name:ROIZENTAL, MOISES (MD)
Entity Type:Individual
Prefix:
First Name:MOISES
Middle Name:
Last Name:ROIZENTAL
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:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:CIRCLE PINES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-0577
Mailing Address - Country:US
Mailing Address - Phone:612-669-7173
Mailing Address - Fax:651-490-7797
Practice Address - Street 1:4770 BISCAYNE BLVD STE 880
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3235
Practice Address - Country:US
Practice Address - Phone:305-674-7575
Practice Address - Fax:651-490-7797
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME700242085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology