MEDICARE: TODD KENNETH ROSENTHAL MD PA

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	207R00000X	Internal Medicine Physician	ME0043503	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	98756	OTHER	FL	MEDICARE GROUP NUMBER

General Provider Information

NPI Number	:	1871621557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TODD KENNETH ROSENTHAL MD PA

Provider Business Mailing Address
First Line	:	8004 N ARMENIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-2763
Country	:	US
Telephone Number	:	813-933-9131
Fax Number	:	813-933-9721

Provider Business Practice Location Address
First Line	:	8004 N ARMENIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-2763
Country	:	US
Telephone Number	:	813-933-9131
Fax Number	:	813-933-9721

Authorized Official
Title or Position	:	OWNER
Name	:	MR. TODD KENNETH ROSENTHAL
Credential	:	M.D.
Telephone Number	:	813-933-9131

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	12/29/2011

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