Provider Demographics
NPI:1255370490
Name:ROYSTON, BETH (MD)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:ROYSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST
Mailing Address - Street 2:SUITE 415
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2927
Mailing Address - Country:US
Mailing Address - Phone:312-926-3627
Mailing Address - Fax:312-694-4102
Practice Address - Street 1:676 N SAINT CLAIR ST
Practice Address - Street 2:SUITE 415
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2927
Practice Address - Country:US
Practice Address - Phone:312-926-3627
Practice Address - Fax:312-694-4102
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036089819207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG08809Medicare UPIN