Provider Demographics
NPI:1235124066
Name:ROGERS, JOHN CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHARLES
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3738 S 60TH ST
Mailing Address - Street 2:STE 102
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53220-1935
Mailing Address - Country:US
Mailing Address - Phone:414-321-9111
Mailing Address - Fax:414-321-9112
Practice Address - Street 1:3738 S 60TH ST
Practice Address - Street 2:STE 102
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53220-1935
Practice Address - Country:US
Practice Address - Phone:414-321-9111
Practice Address - Fax:414-321-9112
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI20247020207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30364700Medicaid
B56119Medicare UPIN
WI30364700Medicaid