Provider Demographics
NPI:1679527618
Name:ROTH, JAMES A (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:ROTH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DIVISION OF CARDIOLOGY AND ELECTROPHYSIOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-6204
Mailing Address - Fax:414-890-5877
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DIVISION OF CARDIOLOGY AND ELECTROPHYSIOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-6204
Practice Address - Fax:414-890-5877
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2022-12-13
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Provider Licenses
StateLicense IDTaxonomies
WI36221207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1679527618Medicaid
002000139POtherHUMANA
WI68086 0677Medicare PIN
WI082E73601Medicare PIN
WI1679527618Medicaid