Provider Demographics
NPI:1548418197
Name:ROTH, MICHAEL PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PAUL
Last Name:ROTH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4545 R ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3799
Mailing Address - Country:US
Mailing Address - Phone:402-465-4545
Mailing Address - Fax:402-465-9011
Practice Address - Street 1:4545 R ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503-3799
Practice Address - Country:US
Practice Address - Phone:402-465-4545
Practice Address - Fax:402-465-9011
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2014-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE26164207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE097850008Medicare PIN