Individual
JODI M ROQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1819 N HARLEM AVE STE A, CHICAGO, IL 60707-3716
(773) 589-4385
(872) 228-8601
Mailing address
PO BOX 746715, ATLANTA, GA 30374-6715
(773) 352-1515
(312) 929-0373
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036158109
IL
207Q00000X
Family Medicine Physician
190472
NC
207Q00000X
Family Medicine Physician
LP01622
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036158109
—
IL
01
—
MD13982
MEDICAL LICENSE
RI
Enumeration date
06/26/2009
Last updated
06/10/2025
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