Healthcare Provider Details

I. General information

NPI: 1568899896
Provider Name (Legal Business Name): MOISES ROIZENTAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 BISCAYNE BLVD STE 880
MIAMI FL
33137-3235
US

IV. Provider business mailing address

PO BOX 577
CIRCLE PINES MN
55014-0577
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-7575
  • Fax: 651-490-7797
Mailing address:
  • Phone: 612-669-7173
  • Fax: 651-490-7797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME70024
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: