Roethlisberger, Mirko
Roethlisberger, Mirko is an individual health care provider with primary practice located at 1050 Old Camp Rd , The Villages FL 32162-1762. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Roethlisberger, Mirko can be contacted via phone (352) 674-1760.Contact Information
Primary practice address
1050 Old Camp Rd
The Villages FL 32162-1762
Phone: (352) 674-1760
Fax: (352) 674-8960
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 222082 | New York |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | ME118494 | Florida |
Profile Details
| NPI number | 1205885480 |
|---|---|
| LBN Legal business name | Roethlisberger, Mirko |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 8th, 2006 |
| Last updated | Jan 29th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1205885480 | NPPES |
| Other | 010222082 | BLUE CROSS BLUE SHIELD | |
| Other | 109768BJ | BLUE CROSS BLUE SHIELD | |
| MEDICAID | 02445563 | BLUE CROSS BLUE SHIELD |
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