Healthcare Provider Details

I. General information

NPI: 1255358685
Provider Name (Legal Business Name): ALEXANDER ROITSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 GREENBRIER RD STE 320
GREEN BAY WI
54311-6519
US

IV. Provider business mailing address

2845 GREENBRIER RD STE 320 PO BOX 8900
GREEN BAY WI
54308-8900
US

V. Phone/Fax

Practice location:
  • Phone: 920-288-8320
  • Fax: 920-288-8325
Mailing address:
  • Phone: 920-288-8320
  • Fax: 920-288-8325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number43565
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: