Provider Demographics
NPI:1851586143
Name:ROSKAM, JONATHAN RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:RICHARD
Last Name:ROSKAM
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 1:14477 TWIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-9725
Mailing Address - Country:US
Mailing Address - Phone:317-846-0736
Mailing Address - Fax:
Practice Address - Street 1:1500 ALBANY ST
Practice Address - Street 2:
Practice Address - City:BEECH GROVE
Practice Address - State:IN
Practice Address - Zip Code:46107-1555
Practice Address - Country:US
Practice Address - Phone:317-532-7800
Practice Address - Fax:317-532-7801
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032218A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine