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General NPI Number Information
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NPI Number | 1568464394
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Entity Type | Organization
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Legal Business Name | ANDREW A. ROTH, M.D.,S.C.
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 500 E 22ND ST STE A
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City | LOMBARD
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State | IL
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Zip | 60148-6102
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Country | US
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Telephone | 630-932-2055
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Fax | 630-932-2059
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Provider Business Mailing Address
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Address Line | 500 E 22ND ST STE A
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City | LOMBARD
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State | IL
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Zip | 60148-6102
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Country | US
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Telephone | 630-932-2055
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Fax | 630-932-2059
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Authorized Official
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Title or Position | BILLING COORDINATOR
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Name | VERONICA GALICA
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Credential |
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Telephone | 630-932-2055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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