Provider Demographics
NPI:1386721991
Name:ROTHMAN, MICHAEL ERIC (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ERIC
Last Name:ROTHMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9933 LAWLER AVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3703
Mailing Address - Country:US
Mailing Address - Phone:847-677-3399
Mailing Address - Fax:
Practice Address - Street 1:9933 LAWLER AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3703
Practice Address - Country:US
Practice Address - Phone:847-677-3399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU06115Medicare UPIN
IL933030Medicare ID - Type Unspecified