Provider Demographics
NPI:1164545505
Name:ARTEAGA, ROQUE BERNARDO (MD, FACC)
Entity Type:Individual
Prefix:
First Name:ROQUE
Middle Name:BERNARDO
Last Name:ARTEAGA
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:ROQUE
Other - Middle Name:BERNARDO
Other - Last Name:ARTEAGA AMEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3128
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51102-3128
Mailing Address - Country:US
Mailing Address - Phone:712-239-4702
Mailing Address - Fax:712-224-5898
Practice Address - Street 1:5885 SUNNYBROOK DR
Practice Address - Street 2:SUITE L-200
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4203
Practice Address - Country:US
Practice Address - Phone:712-239-4702
Practice Address - Fax:712-224-5898
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056946207RC0000X
NE24611207RC0000X, 207RC0001X
SD9515207RC0001X, 207RC0000X
IAMD-41710207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47070592300Medicaid
IA0202491Medicaid
P00980993OtherRAILROAD MEDICARE
NE47070592305Medicaid
KS200566490AMedicaid
NE47070592306Medicaid
NE47070592313Medicaid
NE47070592301Medicaid
NE47070592302Medicaid
NE098570004Medicare PIN
NE47070592300Medicaid
NE47070592301Medicaid
NENA1079018Medicare PIN