Provider Demographics
NPI:1922037308
Name:ROCHE, FLORENCE A (DO)
Entity Type:Individual
Prefix:
First Name:FLORENCE
Middle Name:A
Last Name:ROCHE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 HOME AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-3404
Mailing Address - Country:US
Mailing Address - Phone:773-590-2562
Mailing Address - Fax:708-763-0245
Practice Address - Street 1:RESURRECTION IMMEDIATE CARE CENTER
Practice Address - Street 2:7230 W. NORTH AVE, STE 106 B
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-4262
Practice Address - Country:US
Practice Address - Phone:708-453-3000
Practice Address - Fax:708-453-4660
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108887207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108887Medicaid
IL1619414OtherBCBS GROUP
IL3633309286030501Medicaid
ILK20241Medicare PIN
ILK53675 ICCMedicare PIN
IL3633309286030501Medicaid
ILI39398Medicare UPIN