| Roque-ponton Medical Group, S.c. | |
|
2740 W Foster Ave Suite 313 Chicago IL 60625-3500 | |
| (773) 271-4455 | |
| (773) 271-4540 |
| Full Name | Roque-ponton Medical Group, S.c. |
|---|---|
| Speciality | General Practice |
| Location | 2740 W Foster Ave, Chicago, Illinois |
| Authorized Official Name and Position | David Lopez Roque (PRESIDENT) |
| Authorized Official Contact | 7732713344 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Roque-ponton Medical Group, S.c. 3861 W Pratt Ave Lincolnwood IL 60712-2544 Ph: (773) 271-3344 | Roque-ponton Medical Group, S.c. 2740 W Foster Ave Suite 313 Chicago IL 60625-3500 Ph: (773) 271-4455 |
| NPI Number | 1457570459 |
|---|---|
| Provider Enumeration Date | 04/25/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 6901812635 |
|---|---|
| Medicare Enrollment ID | O20060303000445 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457570459 | NPI | - | NPPES |
| 38340020 | Other | WI | FAMILY PRACTICE |
| 5348 | Other | AK | FAMILY PRACTICE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Primary |
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | David L Roque |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770502940 PECOS PAC ID: 7618983347 Enrollment ID: I20060303000484 |
Philip K Mccullough Md Sc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 201 E Huron St, Suite 11-100, Chicago, IL 60611 Phone: 312-695-3680 Fax: 312-926-3709 | |
Amy Lynn, Lcpc, Atr Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3020 N Lincoln Ave, Flourish Studios, Chicago, IL 60657 Phone: 773-746-7429 | |
K.a.m Alliance, Inc. Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 2215 W 95th St Ste 100, Chicago, IL 60643 Phone: 773-239-9600 Fax: 773-239-9601 | |
King Community Mental Health Center Corp Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4455 S King Drive, Suite 101, Chicago, IL 60653 Phone: 773-536-2700 Fax: 773-751-2250 | |
Young Adult Program Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4219 N Lincoln Ave, Chicago, IL 60618 Phone: 773-572-5500 Fax: 773-537-3488 | |
Professional Diagnostic Service, S.c. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 821 W Van Buren St, Chicago, IL 60607 Phone: 312-491-0404 Fax: 312-491-0505 | |
Universal Medical Group Ltd. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 809 E 42nd Pl, Chicago, IL 60653 Phone: 773-285-3422 |