Provider Demographics
NPI:1174761126
Name:ROSENTAL, MIRA (MD)
Entity type:Individual
Prefix:
First Name:MIRA
Middle Name:
Last Name:ROSENTAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 NE 163 STR.
Mailing Address - Street 2:SUITE 402
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162
Mailing Address - Country:US
Mailing Address - Phone:305-944-4111
Mailing Address - Fax:305-944-1333
Practice Address - Street 1:3250 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-3609
Practice Address - Country:US
Practice Address - Phone:305-441-0304
Practice Address - Fax:305-441-2947
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47786207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology