Provider Demographics
NPI:1568464394
Name:ANDREW A. ROTH, M.D.,S.C.
Entity Type:Organization
Organization Name:ANDREW A. ROTH, M.D.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-932-2055
Mailing Address - Street 1:500 E 22ND ST STE A
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6102
Mailing Address - Country:US
Mailing Address - Phone:630-932-2055
Mailing Address - Fax:630-932-2059
Practice Address - Street 1:500 E 22ND ST STE A
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6102
Practice Address - Country:US
Practice Address - Phone:630-932-2055
Practice Address - Fax:630-932-2059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty