Provider Demographics
NPI:1174577787
Name:ROHACZ, EUGENE D (DPMPC)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:D
Last Name:ROHACZ
Suffix:
Gender:M
Credentials:DPMPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-4025
Mailing Address - Country:US
Mailing Address - Phone:517-439-3338
Mailing Address - Fax:517-780-9811
Practice Address - Street 1:241 W CARLETON RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-5033
Practice Address - Country:US
Practice Address - Phone:517-439-3338
Practice Address - Fax:517-780-9811
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001700213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3054981Medicaid
MI1309330001Medicare NSC
MIU46256Medicare UPIN
MI3054981Medicaid