1114919230 NPI number — CHESLOVAS ROTHSCHILD MD PHD FACS

Table of content: RACHEL G. SOLSTAD MD (NPI 1497216170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114919230 NPI number — CHESLOVAS ROTHSCHILD MD PHD FACS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROTHSCHILD
Provider First Name:
CHESLOVAS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD PHD FACS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VAICYS
Provider Other First Name:
CESLOVAS
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1114919230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1887 KINGSLEY AVE
Provider Second Line Business Mailing Address:
SUITE1900
Provider Business Mailing Address City Name:
ORANGE PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32073-4416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-276-7336
Provider Business Mailing Address Fax Number:
904-276-7337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1887 KINGSLEY AVE
Provider Second Line Business Practice Location Address:
SUITE1900
Provider Business Practice Location Address City Name:
ORANGE PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32073-4416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-276-7336
Provider Business Practice Location Address Fax Number:
904-276-7337
Provider Enumeration Date:
08/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  4301064527 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1114919230 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 005530600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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