Provider Demographics
NPI:1184712994
Name:ROTH, ABBIE H (MD)
Entity type:Individual
Prefix:MS
First Name:ABBIE
Middle Name:H
Last Name:ROTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:680 N LAKE SHORE DRIVE
Mailing Address - Street 2:STE 1200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4546
Mailing Address - Country:US
Mailing Address - Phone:312-440-9400
Mailing Address - Fax:312-440-0423
Practice Address - Street 1:680 N LAKE SHORE DRIVE
Practice Address - Street 2:STE 1200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4546
Practice Address - Country:US
Practice Address - Phone:312-440-9400
Practice Address - Fax:312-440-0423
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
L78080Medicare ID - Type Unspecified
H14885Medicare UPIN