Provider Demographics
NPI:1932184140
Name:ROSENZWEIG, JONATHAN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:ROSENZWEIG
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28625 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 213
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1828
Mailing Address - Country:US
Mailing Address - Phone:248-354-9666
Mailing Address - Fax:248-354-3653
Practice Address - Street 1:28625 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 213
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1828
Practice Address - Country:US
Practice Address - Phone:248-354-9666
Practice Address - Fax:248-354-3653
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301027055207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1932184140Medicaid
MI1102020016OtherRR MEDICARE
MI700F314390OtherBLUE SHIELD
MI0630193OtherBCBS INDIVIDUAL
MI0M96210037Medicare PIN
MIB44802Medicare UPIN