Healthcare Provider Details

I. General information

NPI: 1114919230
Provider Name (Legal Business Name): CHESLOVAS ROTHSCHILD MD PHD FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CESLOVAS VAICYS M.D.

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 01/28/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1887 KINGSLEY AVE SUITE1900
ORANGE PARK FL
32073-4416
US

IV. Provider business mailing address

1887 KINGSLEY AVE SUITE1900
ORANGE PARK FL
32073-4416
US

V. Phone/Fax

Practice location:
  • Phone: 904-276-7336
  • Fax: 904-276-7337
Mailing address:
  • Phone: 904-276-7336
  • Fax: 904-276-7337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number4301064527
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: