Provider Demographics
NPI:1972122455
Name:ROTHCHILD, JASON TYLER (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:TYLER
Last Name:ROTHCHILD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8558 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7032
Mailing Address - Country:US
Mailing Address - Phone:219-392-7084
Mailing Address - Fax:219-703-6854
Practice Address - Street 1:10240 CALUMET AVE FL 2
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4082
Practice Address - Country:US
Practice Address - Phone:197-038-2992
Practice Address - Fax:219-703-6517
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01088579A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300072641Medicaid
IN1102860751OtherANTHEM