Roth, Daniel Christopher

Roth, Daniel Christopher is an individual health care provider with primary practice located at 1721 Magnavox Way , Fort Wayne IN 46804-1537. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, Allopathic & Osteopathic Physicians / Interventional Pain Medicine. Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation is his primary health care specialty. Roth, Daniel Christopher can be contacted via phone (260) 748-3650.

Contact Information

Primary practice address
1721 Magnavox Way Fort Wayne IN 46804-1537
Phone: (260) 748-3650
Fax: (260) 748-3651
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 125050599 Illinois
Allopathic & Osteopathic Physicians / Interventional Pain Medicine 208VP0014X 02003462A Indiana
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 02003462A Indiana

Profile Details

NPI number 1861687923
LBN Legal business name Roth, Daniel Christopher
Credentials DO, MBA, MS
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 12th, 2007
Last updated Feb 4th, 2019 - about 7 years 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861687923 NPPES
Indiana Other 790872 BCBS
Indiana MEDICAID 200938070 BCBS

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