Individual
DR. MICHAEL JOHN ROTHEKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
17615 STATE ROAD 23, SOUTH BEND, IN 46635
(574) 234-7600
(574) 234-8408
Mailing address
4121 S. MICHIGAN STREET, SOUTH BEND, IN 46614-2545
(574) 291-9200
(574) 299-4423
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003124A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000215766
ANTHEM MC/BS
IN
05
—
200335390A
—
IN
Enumeration date
10/13/2005
Last updated
08/14/2018
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