Provider Demographics
NPI:1700084431
Name:ROSENBLUM, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:ROSENBLUM
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:PO BOX 1738
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-1738
Mailing Address - Country:US
Mailing Address - Phone:843-357-2299
Mailing Address - Fax:843-357-2720
Practice Address - Street 1:4630 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5016
Practice Address - Country:US
Practice Address - Phone:843-357-2299
Practice Address - Fax:843-257-2720
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL30072207R00000X
SC30072207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC300720Medicaid
SCP01204808OtherRAILROAD MEDICARE
SC300720Medicaid
NY239335Medicare UPIN