Healthcare Provider Details

I. General information

NPI: 1538261672
Provider Name (Legal Business Name): MICHAEL P ROSENKRANZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 3RD AVE BONNER GENERAL HOSPITAL
SANDPOINT ID
83864
US

IV. Provider business mailing address

PO BOX 2556
SANDPOINT ID
83864-0917
US

V. Phone/Fax

Practice location:
  • Phone: 208-263-1441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberM-12159
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: