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NPI Code Detail

MEDICARE: DR. CRAIG STEPHEN ROTH MD

MEDICARE:  DR. CRAIG STEPHEN ROTH  MD
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
1207R00000XInternal Medicine Physician34160-020WI

General Provider Information

NPI Number : 1952329559
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CRAIG STEPHEN ROTH MD
Provider Business Mailing Address
First Line : 5117 JAMES AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55419-1134
Country : US
Telephone Number : 612-928-1771
Fax Number :
Provider Business Practice Location Address
First Line : ONE VETERANS DRIVE
Second Line : VETERANS AFFAIRS MEDICAL CENTER GENERAL MEDICINE (1110)
City : MINNEAPOLIS
State : MN
Zip : 55417
Country : US
Telephone Number : 612-725-2158
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 07/08/2007

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Directions to “ DR. CRAIG STEPHEN ROTH MD” Practice Location

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