Provider Demographics
NPI:1962448332
Name:ROSCHE, ALFRED P III (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:P
Last Name:ROSCHE
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:NORTHPOINTE CLINIC
Mailing Address - Street 2:5605 E ROCKTON ROAD
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-7601
Mailing Address - Country:US
Mailing Address - Phone:815-525-4500
Mailing Address - Fax:815-525-4505
Practice Address - Street 1:NORTHPOINTE CLINIC
Practice Address - Street 2:5605 E ROCKTON ROAD
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-7601
Practice Address - Country:US
Practice Address - Phone:815-525-4500
Practice Address - Fax:815-525-4505
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036097335208VP0014X
IL036-097335208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213192Medicare ID - Type Unspecified
ILG33555Medicare UPIN