Healthcare Provider Details

I. General information

NPI: 1760907281
Provider Name (Legal Business Name): NATHAN MICHAEL ROTHCHILD PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 WISHARD BLVD
INDIANAPOLIS IN
46202-2872
US

IV. Provider business mailing address

5301 LANDING PLACE LN
NOBLESVILLE IN
46062-6176
US

V. Phone/Fax

Practice location:
  • Phone: 317-278-3208
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10002305A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: