Individual
DR. SUZANNE ROECKELL MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
40 SKOKIE BLVD STE 520, NORTHBROOK, IL 60062-1601
(847) 504-5000
(847) 504-5015
Mailing address
PO BOX 917, NORTHBROOK, IL 60065-0917
(847) 504-5000
(847) 504-5015
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016004685
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016004685
—
IL
01
—
0732240001
DMERC FOR PPG
IL
Enumeration date
08/08/2006
Last updated
01/22/2019
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