Provider Demographics
NPI:1114039831
Name:PECHEREK-ROGERS, TERESA (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:PECHEREK-ROGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24012 W RENWICK RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-8731
Mailing Address - Country:US
Mailing Address - Phone:815-436-9393
Mailing Address - Fax:815-436-1654
Practice Address - Street 1:24012 W RENWICK RD
Practice Address - Street 2:SUITE 14
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2108
Practice Address - Country:US
Practice Address - Phone:815-436-9393
Practice Address - Fax:815-436-1654
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103443207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9932638OtherBCBS
IL036103443Medicaid
IL036103443Medicaid
H44151Medicare UPIN