MEDICARE: PETER M ROTHMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207KA0200X	Allergy Physician	01026818A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982605937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER M ROTHMAN MD

Provider Business Mailing Address
First Line	:	7920 W JEFFERSON BLVD
Second Line	:	SUITE 220
City	:	FORT WAYNE
State	:	IN
Zip	:	46804
Country	:	US
Telephone Number	:	260-436-5670
Fax Number	:	260-436-4706

Provider Business Practice Location Address
First Line	:	7920 W JEFFERSON BLVD
Second Line	:	SUITE 220
City	:	FORT WAYNE
State	:	IN
Zip	:	46804
Country	:	US
Telephone Number	:	260-436-5670
Fax Number	:	260-436-4706

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	01/29/2010

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