Provider Demographics
NPI:1104796119
Name:WINEMILLER, ROGER (CPRS)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:WINEMILLER
Suffix:
Gender:M
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7630 ROSEWOOD DR APT B
Mailing Address - Street 2:
Mailing Address - City:BLANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45107-1541
Mailing Address - Country:US
Mailing Address - Phone:937-972-3512
Mailing Address - Fax:
Practice Address - Street 1:815 S SOUTH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2755
Practice Address - Country:US
Practice Address - Phone:937-910-6218
Practice Address - Fax:800-480-7578
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-06
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.006397175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty