Provider Demographics
NPI:1649534272
Name:EUGENE D. ROHACZ, D.P.M., P.C.
Entity type:Organization
Organization Name:EUGENE D. ROHACZ, D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:DOMINIC
Authorized Official - Last Name:ROHACZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:517-439-3338
Mailing Address - Street 1:241 W CARLETON RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-5033
Mailing Address - Country:US
Mailing Address - Phone:517-439-3338
Mailing Address - Fax:
Practice Address - Street 1:241 W CARLETON RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-5033
Practice Address - Country:US
Practice Address - Phone:517-439-3338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2017-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001700213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3054981Medicaid
MI3054981Medicaid
MIMI5737Medicare PIN
MI1309330001Medicare NSC