Provider Demographics
NPI:1679714216
Name:ROSKA, JOHN MARTIN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MARTIN
Last Name:ROSKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 SHAW WOODS DR.
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1725
Mailing Address - Country:US
Mailing Address - Phone:815-490-5787
Mailing Address - Fax:866-725-0972
Practice Address - Street 1:1711 SHAW WOODS DR.
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-1725
Practice Address - Country:US
Practice Address - Phone:815-490-5787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-070998314000000X
IL036070998207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine