Provider Demographics
NPI:1659508810
Name:KENNETH M ROSENZWEIG, MD, PA
Entity Type:Organization
Organization Name:KENNETH M ROSENZWEIG, MD, PA
Other - Org Name:ORTHOPAEDIC SPINE & SPORTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSENZWEIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-975-5575
Mailing Address - Street 1:PO BOX 242180
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-0041
Mailing Address - Country:US
Mailing Address - Phone:501-975-5575
Mailing Address - Fax:501-975-5634
Practice Address - Street 1:8907 KANIS RD
Practice Address - Street 2:SUITE 330
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6449
Practice Address - Country:US
Practice Address - Phone:501-975-5575
Practice Address - Fax:501-975-5634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6198207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR180112002Medicaid
AR6398610001Medicare NSC