Provider Demographics
NPI:1730449125
Name:ROQUIZ, WOODLYNE (DO)
Entity type:Individual
Prefix:DR
First Name:WOODLYNE
Middle Name:
Last Name:ROQUIZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 WILMETTE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2400
Mailing Address - Country:US
Mailing Address - Phone:224-408-2278
Mailing Address - Fax:224-408-2293
Practice Address - Street 1:QUEST DIAGNOSTICS
Practice Address - Street 2:506 E STATE PARKWAY
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173
Practice Address - Country:US
Practice Address - Phone:847-755-5176
Practice Address - Fax:224-408-2293
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.134686207ZH0000X, 207ZP0102X
IADO-05056207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036134686Medicaid
ILF400450583OtherMEDICARE