Provider Demographics
NPI:1932347572
Name:EDWARD J ROTMENSCH MD PLLC
Entity Type:Organization
Organization Name:EDWARD J ROTMENSCH MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ROTMENSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD PLLC
Authorized Official - Phone:623-845-0137
Mailing Address - Street 1:PO BOX 5877
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85385-5877
Mailing Address - Country:US
Mailing Address - Phone:623-845-0137
Mailing Address - Fax:623-209-9805
Practice Address - Street 1:8410 W THOMAS RD
Practice Address - Street 2:BLDG 4, SUITE 138
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3329
Practice Address - Country:US
Practice Address - Phone:623-845-0137
Practice Address - Fax:623-209-9805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32594174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZA59358Medicare UPIN