Provider Demographics
NPI:1689673576
Name:ROTHKOPF, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:ROTHKOPF
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 1:1110 COTTONWOOD LN
Mailing Address - Street 2:SUITE 105
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6117
Mailing Address - Country:US
Mailing Address - Phone:972-607-2525
Mailing Address - Fax:972-252-8837
Practice Address - Street 1:1110 COTTONWOOD LN
Practice Address - Street 2:SUITE 105
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-6117
Practice Address - Country:US
Practice Address - Phone:972-607-2525
Practice Address - Fax:972-252-8837
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9371207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133895610Medicaid
TX133895611Medicaid
TX133895609Medicaid
TX133895610Medicaid
TXTXB113309Medicare PIN
TX133895611Medicaid
TX133895609Medicaid
TXTXB113314Medicare PIN