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NPI Code Detail

MEDICARE: ZAHAVA G ROTH PA-C, RD

MEDICARE: ZAHAVA G ROTH PA-C, RD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian164009188IL
2363AM0700XMedical Physician Assistant085.010009IL

General Provider Information

NPI Number : 1033751169
Entity Type Code : Individual
Provider Name (Legal Business Name) : ZAHAVA G ROTH PA-C, RD
Provider Business Mailing Address
First Line : 2831 W FITCH AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60645-2905
Country : US
Telephone Number : 773-595-6678
Fax Number :
Provider Business Practice Location Address
First Line : 1300 W DEVON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60660-1302
Country : US
Telephone Number : 773-751-7850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2019
Last Update Date : 10/15/2023

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