# ROQUE-PONTON MEDICAL GROUP, S.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457570459
- **Authorized official:** DR. DAVID LOPEZ ROQUE M.D. (PRESIDENT)
- **Authorized official phone:** (773) 271-3344

## Contact information

- **Practice address:** 2740 W FOSTER AVE, SUITE 313, CHICAGO, IL 60625-3500
- **Practice address phone:** (773) 271-4455
- **Practice address fax:** (773) 271-4540
- **Mailing address:** 3861 W PRATT AVE, LINCOLNWOOD, IL 60712-2544
- **Mailing address phone:** (773) 271-3344
- **Mailing address fax:** (773) 271-4540

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | Yes |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | Yes |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |

## Other

- **Enumeration date:** 04/25/2007
- **Last updated:** 09/11/2025