Individual
KELLY ANN ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2529
(217) 383-4633
Mailing address
611 W PARK ST, URBANA, IL 61801-2529
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036159787
IL
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
036159787
IL
207RP1001X
Pulmonary Disease Physician
036159787
IL
Other
Enumeration date
07/11/2019
Last updated
06/13/2025
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