Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 4301064527 | MI |
NPI | 1114919230 |
---|---|
Provider Name | Cheslovas Rothschild |
First Address | Orange Park, FL 32073-4416 |
Second Address | Orange Park, FL 32073-4416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 28/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005530600 | (05) | FL |
1114919230 | (05) | MI |