Individual
JASON TYLER ROTHCHILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10240 CALUMET AVE FL 2, MUNSTER, IN 46321-4082
(197) 038-2992
(219) 703-6517
Mailing address
8558 BROADWAY, MERRILLVILLE, IN 46410-7032
(219) 392-7084
(219) 703-6854
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01088579A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1102860751
ANTHEM
IN
05
—
300072641
—
IN
Enumeration date
04/14/2020
Last updated
09/12/2024
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