Provider Demographics
NPI:1821016601
Name:ROSENBERG, MICHAEL LAWRENCE (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LAWRENCE
Last Name:ROSENBERG
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 1:1831 HALCYON BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8044
Mailing Address - Country:US
Mailing Address - Phone:334-396-3668
Mailing Address - Fax:334-396-3660
Practice Address - Street 1:1831 HALCYON BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8044
Practice Address - Country:US
Practice Address - Phone:334-396-3668
Practice Address - Fax:334-396-3660
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL213E00000X213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51079567OtherBLUE CROSS OF ALABAMA
AL480026191OtherMEDICARE RAILROAD
ALU70041Medicare UPIN
AL480026191OtherMEDICARE RAILROAD
AL51079567OtherBLUE CROSS OF ALABAMA