Basic Information
Provider Information
NPI: 1770539850
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROSENFIELD
FirstName: THOMAS
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5401 S CONGRESS AVE STE 211
Address2:  
City: ATLANTIS
State: FL
PostalCode: 334626637
CountryCode: US
TelephoneNumber: 5619648221
FaxNumber: 5619647393
Practice Location
Address1: 5401 S CONGRESS AVE
Address2: # 211
City: ATLANTIS
State: FL
PostalCode: 334626635
CountryCode: US
TelephoneNumber: 5619648221
FaxNumber: 5619647393
Other Information
ProviderEnumerationDate: 05/26/2006
LastUpdateDate: 01/15/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/15/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0100XME37886FLY Allopathic & Osteopathic PhysiciansInternal MedicineGastroenterology

No ID Information.


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