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:
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Health care specialties

SpecialtyCodeLicense #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 2 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 1174503866 NPPES
Indiana MEDICAID 300020434

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