Individual
STEPHEN ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
412 63RD ST, SUITE 105, DOWNERS GROVE, IL 60516-2000
(630) 915-5437
Mailing address
100 W MONROE ST, CHICAGO, IL 60603-1967
(630) 915-5437
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0021627803
BLUE CROSS ID
IL
Enumeration date
10/02/2006
Last updated
07/08/2007
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