Roth, Ted M.
Roth, Ted M. is an individual health care provider with primary practice located at 621 Memorial Dr Ste 302 , South Bend IN 46601-1073. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, Allopathic & Osteopathic Physicians / Female Pelvic Medicine and Reconstructive Surgery. Allopathic & Osteopathic Physicians / Female Pelvic Medicine and Reconstructive Surgery is his primary health care specialty. Roth, Ted M. can be contacted via phone (574) 367-3800.Contact Information
Primary practice address
621 Memorial Dr Ste 302
South Bend IN 46601-1073
Phone: (574) 367-3800
Fax: (574) 367-3801
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | 01081226A | Indiana |
| Allopathic & Osteopathic Physicians / Female Pelvic Medicine and Reconstructive Surgery | 207VF0040X | 01081226A | Indiana |
Profile Details
| NPI number | 1174503866 |
|---|---|
| LBN Legal business name | Roth, Ted M. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 19th, 2006 |
| Last updated | Jun 25th, 2024 - about 5 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1174503866 | NPPES |
| Indiana | MEDICAID | 300020434 |
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