Healthcare Provider Details

I. General information

NPI: 1730449125
Provider Name (Legal Business Name): WOODLYNE ROQUIZ D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 GULL RD
KALAMAZOO MI
49048-1640
US

IV. Provider business mailing address

26104 W STEWART RIDGE DR
PLAINFIELD IL
60585-5301
US

V. Phone/Fax

Practice location:
  • Phone: 330-212-0819
  • Fax:
Mailing address:
  • Phone: 630-848-9099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number036.134686
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberOP61342379
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036.134686
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: