Provider Demographics
NPI:1124279385
Name:ROXAS, RODERICK CARLUEN (MD)
Entity type:Individual
Prefix:
First Name:RODERICK
Middle Name:CARLUEN
Last Name:ROXAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E ONTARIO ST APT 710
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3066
Mailing Address - Country:US
Mailing Address - Phone:312-864-0060
Mailing Address - Fax:
Practice Address - Street 1:1653 W CONGRESS PKWY
Practice Address - Street 2:SUITE 177 MURDOCK
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3833
Practice Address - Country:US
Practice Address - Phone:312-942-4978
Practice Address - Fax:312-942-4021
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.051432207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine