Individual
DR. JEFFREY DAVID ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
25 E WASHINGTON ST, SUITE 1811, CHICAGO, IL 60602-1708
(312) 444-1041
(312) 444-1048
Mailing address
25 E WASHINGTON ST, SUITE 1811, CHICAGO, IL 60602-1708
(312) 444-1041
(312) 444-1048
Taxonomy
Speciality
Code
Description
License number
State
2084P0802X
Addiction Psychiatry Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0031600526
BC/BS
IL
Enumeration date
08/01/2006
Last updated
07/08/2007
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