Provider Demographics
NPI:1871570705
Name:ROTENBERG, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ROTENBERG
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 23238
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77720-3238
Mailing Address - Country:US
Mailing Address - Phone:409-225-1458
Mailing Address - Fax:409-724-0371
Practice Address - Street 1:2415 SAN FELIPE ST UNIT 3
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-2509
Practice Address - Country:US
Practice Address - Phone:409-225-1458
Practice Address - Fax:409-724-0371
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9416207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1148405 01Medicaid
TXB89843Medicare UPIN
TX00G81BMedicare ID - Type Unspecified