Individual
MR. ALDRIN CODILLA ROQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2401 W. UNIVERSITY AVENUE, MUNCIE, IN 47303
(765) 741-1515
(765) 751-5087
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01074559A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200452010
—
IN
05
—
201090730
—
IN
01
—
256480040
MEDICARE
IN
Enumeration date
04/18/2012
Last updated
03/20/2023
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