Provider Demographics
NPI:1386600336
Name:ROSENFELD, CALVIN S (MD ,)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:S
Last Name:ROSENFELD
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 1:3700 WASHINGTON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8256
Mailing Address - Country:US
Mailing Address - Phone:954-983-6307
Mailing Address - Fax:954-983-5809
Practice Address - Street 1:3700 WASHINGTON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8256
Practice Address - Country:US
Practice Address - Phone:954-983-6307
Practice Address - Fax:954-983-5809
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0037885174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372136100Medicaid
FLC06975Medicare UPIN
FL372136100Medicaid