MEDICARE: DR. ALFRED P ROSCHE III M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician	036097335	IL
2	208VP0014X	Interventional Pain Medicine Physician	036-097335	IL

General Provider Information

NPI Number	:	1962448332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFRED P ROSCHE III M.D.

Provider Business Mailing Address
First Line	:	NORTHPOINTE CLINIC
Second Line	:	5605 E ROCKTON ROAD
City	:	ROSCOE
State	:	IL
Zip	:	61073-7601
Country	:	US
Telephone Number	:	815-525-4500
Fax Number	:	815-525-4505

Provider Business Practice Location Address
First Line	:	NORTHPOINTE CLINIC
Second Line	:	5605 E ROCKTON ROAD
City	:	ROSCOE
State	:	IL
Zip	:	61073-7601
Country	:	US
Telephone Number	:	815-525-4500
Fax Number	:	815-525-4505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	12/21/2022

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