Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 01052490A | IN |
NPI | 1134106297 |
---|---|
Provider Name | Michael C Rotkis |
First Address | South Bend, IN 46601-1064 |
Second Address | South Bend, IN 46601-1064 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 13/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H20933 | (02) | IN |