Individual
NICHOLAS CONNOR ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
701 N 1ST ST, SPRINGFIELD, IL 62702-3757
(217) 545-4401
Mailing address
701 N 1ST ST, SPRINGFIELD, IL 62702-3757
(217) 545-4401
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
125083173
IL
Other
Enumeration date
05/15/2024
Last updated
05/15/2024
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