Provider Demographics
NPI:1154765790
Name:ROEPKE, GEORGE HERMAN III
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:HERMAN
Last Name:ROEPKE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 REMINGTON BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-5114
Mailing Address - Country:US
Mailing Address - Phone:630-914-2714
Mailing Address - Fax:630-214-2469
Practice Address - Street 1:711 W NORTH AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-1174
Practice Address - Country:US
Practice Address - Phone:312-280-0996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036138697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine