Provider Demographics
NPI:1659794311
Name:ROKOSCH, DONALD KARL JOSEPH (MD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:KARL JOSEPH
Last Name:ROKOSCH
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 1:1433 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-2516
Mailing Address - Country:US
Mailing Address - Phone:217-474-1254
Mailing Address - Fax:
Practice Address - Street 1:1433 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-2516
Practice Address - Country:US
Practice Address - Phone:217-474-1254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-058411207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036068411Medicaid
IL663720Medicare UPIN