Basic Information
| Provider Information | |||||||||
| NPI: | 1346479920 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAZE-ROTHSTEIN | ||||||||
| FirstName: | GALEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 812 AVIS DR | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481089649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342133931 | ||||||||
| FaxNumber: | 7349260090 | ||||||||
| Practice Location | |||||||||
| Address1: | 3544 NW ASTOR ST | ||||||||
| Address2: | |||||||||
| City: | CAMAS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986078580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342133931 | ||||||||
| FaxNumber: | 7349260090 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2009 | ||||||||
| LastUpdateDate: | 04/20/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | TRN14090 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.