Organization
ROQUE-PONTON MEDICAL GROUP, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID LOPEZ ROQUE M.D. (PRESIDENT)
(773) 271-3344
Entity
Organization
Contact information
Practice address
2740 W FOSTER AVE, SUITE 313, CHICAGO, IL 60625-3500
(773) 271-4455
(773) 271-4540
Mailing address
3861 W PRATT AVE, LINCOLNWOOD, IL 60712-2544
(773) 271-3344
(773) 271-4540
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38340020
FAMILY PRACTICE
WI
01
—
5348
FAMILY PRACTICE
AK
Enumeration date
04/25/2007
Last updated
09/11/2025
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