Individual
ELLIOT ROTH
Active
Individual
ELLIOT ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
036-067061
IL
2081P0004X
Spinal Cord Injury Medicine Physician
036-067061
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036067061
—
IL
01
—
250011651
RAILROAD MEDICARE
IL
01
—
250011934
RAILROAD MEDICARE
IL
Enumeration date
08/01/2006
Last updated
07/21/2022
Update your record
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