Healthcare Provider Details

I. General information

NPI: 1447870340
Provider Name (Legal Business Name): ANNA MARIA JACQUES DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA MARIA ROMAN-PLESCHKO

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 ROXBURY RD
ROCKFORD IL
61107-5090
US

IV. Provider business mailing address

PO BOX 735263
CHICAGO IL
60673-5263
US

V. Phone/Fax

Practice location:
  • Phone: 815-398-9491
  • Fax: 815-381-7498
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036179207
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2025015056
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number036179207
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: