Provider Demographics
NPI:1467682690
Name:ROQUE, DARIO (MD)
Entity Type:Individual
Prefix:
First Name:DARIO
Middle Name:
Last Name:ROQUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:250 E SUPERIOR ST STE 4-420
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2914
Mailing Address - Country:US
Mailing Address - Phone:312-695-0990
Mailing Address - Fax:312-472-4706
Practice Address - Street 1:250 E SUPERIOR ST STE 4-420
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2914
Practice Address - Country:US
Practice Address - Phone:312-695-0990
Practice Address - Fax:312-472-4706
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC189351207VX0201X
RIMD15302207VX0201X
IL036151768207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology