Provider Demographics
NPI:1376961284
Name:GARCIA, ROXANNA MELISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROXANNA
Middle Name:MELISSA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12255 S 80TH AVE STE 2032210
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1270
Mailing Address - Country:US
Mailing Address - Phone:708-827-2021
Mailing Address - Fax:708-827-2241
Practice Address - Street 1:12255 S 80TH AVE STE 2032210
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1270
Practice Address - Country:US
Practice Address - Phone:708-827-2021
Practice Address - Fax:708-827-2241
Is Sole Proprietor?:No
Enumeration Date:2014-03-29
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1376961284207T00000X
IL036155028207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1376961284Medicaid