MEDICARE: DR. MICHAEL J. ROZEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173000000X	Legal Medicine	3530165R	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35030165R	OTHER	OH	MEDICAL LICENSE

General Provider Information

NPI Number	:	1427075159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL J. ROZEN M.D.

Provider Business Mailing Address
First Line	:	10901 REED HARTMAN HWY
Second Line	:	SUITE 223
City	:	CINCINNATI
State	:	OH
Zip	:	45242-2831
Country	:	US
Telephone Number	:	513-984-2435
Fax Number	:

Provider Business Practice Location Address
First Line	:	10901 REED HARTMAN HWY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45242-2831
Country	:	US
Telephone Number	:	513-984-2435
Fax Number	:	859-818-6220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/08/2007

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