Healthcare Provider Details

I. General information

NPI: 1659470201
Provider Name (Legal Business Name): MARK J ROSENTHAL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 12/16/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 BAPTIST WAY
HOMESTEAD FL
33033-7600
US

IV. Provider business mailing address

7260 SW 165TH ST
PALMETTO BAY FL
33157-2503
US

V. Phone/Fax

Practice location:
  • Phone: 305-779-7022
  • Fax:
Mailing address:
  • Phone: 305-510-3849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS 5502
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License NumberOS5502
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: