Individual
TED M. ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
621 MEMORIAL DR STE 302, SOUTH BEND, IN 46601-1073
(574) 367-3800
(574) 367-3801
Mailing address
1115 BURNS ST, SOUTH BEND, IN 46617-4403
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
01081226A
IN
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
01081226A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300020434
—
IN
Enumeration date
01/19/2006
Last updated
01/03/2025
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