Provider Demographics
NPI:1164663381
Name:ROGOW, LINDA REBEKAH (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:REBEKAH
Last Name:ROGOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:REBEKAH
Other - Last Name:DEERFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 71260
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-7360
Mailing Address - Country:US
Mailing Address - Phone:262-617-6330
Mailing Address - Fax:
Practice Address - Street 1:2501 W SILVER SPRING DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-4217
Practice Address - Country:US
Practice Address - Phone:414-461-9250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI # 37150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine