Provider Demographics
NPI:1063479202
Name:ROGIN, ALAN MELVIN (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:MELVIN
Last Name:ROGIN
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 1:5140 N CALIFORNIA AVE
Mailing Address - Street 2:SUITE 775
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3657
Mailing Address - Country:US
Mailing Address - Phone:773-878-7555
Mailing Address - Fax:773-878-8545
Practice Address - Street 1:5140 N CALIFORNIA AVE
Practice Address - Street 2:SUITE 775
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3657
Practice Address - Country:US
Practice Address - Phone:773-878-7555
Practice Address - Fax:773-878-8545
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36040493208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036040493Medicaid
K20407Medicare PIN
C38143Medicare UPIN
5514060010Medicare NSC
IL036040493Medicaid