Individual
MR. MICHAEL ANDREW ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAA
Contact information
Practice address
201 NW R D MIZE RD, BLUE SPRINGS, MO 64014-2513
(816) 228-5900
Mailing address
3645 NW BLUE JACKET DR, LEES SUMMIT, MO 64064-3017
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
2017017852
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255860029
—
MO
01
—
58303041
BCBS KC
MO
01
—
P02320854
RAILROAD
MO
Enumeration date
06/06/2017
Last updated
12/18/2020
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