Provider Demographics
NPI:1750369922
Name:ROSENZWEIG, KENNETH M (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:M
Last Name:ROSENZWEIG
Suffix:
Gender:M
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:PO BOX 242180
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-0041
Mailing Address - Country:US
Mailing Address - Phone:501-975-5575
Mailing Address - Fax:501-975-5634
Practice Address - Street 1:8907 KANIS RD
Practice Address - Street 2:SUITE 330
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6449
Practice Address - Country:US
Practice Address - Phone:501-975-5575
Practice Address - Fax:501-975-5634
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6198174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR114646001Medicaid
AR114646001Medicaid
ARB90200Medicare UPIN