Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 036151768 | IL |
N | 207VX0201X | Gynecologic Oncologist | 189351 | NC |
N | 207VX0201X | Gynecologic Oncologist | MD15302 | RI |
NPI | 1467682690 |
---|---|
Provider Name | Dario Roque |
First Address | Chicago, IL 60611-2914 |
Second Address | Chicago, IL 60611-2914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2009 |
Last Update Date | 06/08/2020 |