Provider Demographics
NPI:1770706798
Name:PLOTKIN, ROGER PEYTON (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:PEYTON
Last Name:PLOTKIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1319 CHICAGO AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-5303
Mailing Address - Country:US
Mailing Address - Phone:847-570-9359
Mailing Address - Fax:847-570-9510
Practice Address - Street 1:1319 CHICAGO AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5303
Practice Address - Country:US
Practice Address - Phone:847-570-9359
Practice Address - Fax:847-570-9510
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB20016Medicare UPIN