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General NPI Number Information
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NPI Number | 1679714216
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Entity Type | Individual
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Provider Name | JOHN MARTIN ROSKA MD
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Gender | Male
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Dates
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Enumeration Date | 03/11/2009
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Last Update Date | 12/30/2013
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Provider Practice Location Address
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Address Line | 1711 SHAW WOODS DR.
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City | ROCKFORD
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State | IL
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Zip | 61107-1725
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Country | US
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Telephone | 815-490-5787
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Fax |
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Provider Business Mailing Address
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Address Line | 1711 SHAW WOODS DR.
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City | ROCKFORD
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State | IL
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Zip | 61107-1725
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Country | US
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Telephone | 815-490-5787
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Fax | 866-725-0972
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 036-070998
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036070998
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 036070998
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License Number State | IL
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