Provider Demographics
NPI:1245342286
Name:MICHAEL J ROSENFELD
Entity type:Organization
Organization Name:MICHAEL J ROSENFELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:641-236-2500
Mailing Address - Street 1:210 4TH AVE
Mailing Address - Street 2:MAB 3RD FLOOR
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-1898
Mailing Address - Country:US
Mailing Address - Phone:641-236-2382
Mailing Address - Fax:641-236-2907
Practice Address - Street 1:210 4TH AVE
Practice Address - Street 2:MAB 3RD FLOOR
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-1898
Practice Address - Country:US
Practice Address - Phone:641-236-2382
Practice Address - Fax:641-236-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA329572084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA06847OtherWELLMARK BCBS
IA2186049Medicaid
IAH02266Medicare UPIN
IA2186049Medicaid