MEDICARE: MICHAEL ROTENBERG 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	207RC0000X	Cardiovascular Disease Physician	H9416	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871570705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ROTENBERG M.D.

Provider Business Mailing Address
First Line	:	PO BOX 23238
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77720-3238
Country	:	US
Telephone Number	:	409-225-1458
Fax Number	:	409-724-0371

Provider Business Practice Location Address
First Line	:	2415 SAN FELIPE ST UNIT 3
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-2509
Country	:	US
Telephone Number	:	409-225-1458
Fax Number	:	409-724-0371

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	09/12/2022

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