Provider Demographics
NPI:1013432210
Name:MICHAEL A ROTHBAUM MD LLC
Entity Type:Organization
Organization Name:MICHAEL A ROTHBAUM MD LLC
Other - Org Name:ROTHBAUM EYE AND VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:ROTHBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-319-9205
Mailing Address - Street 1:611 BRYN MAWR DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-4735
Mailing Address - Country:US
Mailing Address - Phone:317-319-9205
Mailing Address - Fax:
Practice Address - Street 1:18077 RIVER RD STE 103
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-8311
Practice Address - Country:US
Practice Address - Phone:317-773-5153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-08
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060465A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty