Provider Demographics
NPI:1629059704
Name:ROETHLING, HANS PETER (MD)
Entity type:Individual
Prefix:
First Name:HANS
Middle Name:PETER
Last Name:ROETHLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 RUSHING DR
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-3748
Mailing Address - Country:US
Mailing Address - Phone:618-998-8808
Mailing Address - Fax:618-998-8809
Practice Address - Street 1:500 RUSHING DR
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3748
Practice Address - Country:US
Practice Address - Phone:618-998-8808
Practice Address - Fax:618-998-8809
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36163285207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8972811Medicaid
222718Medicare ID - Type Unspecified
NC8972811Medicaid