Provider Demographics
NPI:1255663662
Name:B. H. GERALD ROGERS, M.D., LTD
Entity Type:Organization
Organization Name:B. H. GERALD ROGERS, M.D., LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERTRAM
Authorized Official - Middle Name:HENRYGERALD
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-828-9747
Mailing Address - Street 1:505 N LAKE SHORE DR
Mailing Address - Street 2:SUITE 406
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3493
Mailing Address - Country:US
Mailing Address - Phone:312-828-9747
Mailing Address - Fax:
Practice Address - Street 1:505 N LAKE SHORE DR
Practice Address - Street 2:SUITE 406
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3493
Practice Address - Country:US
Practice Address - Phone:312-828-9747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036040176207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036040176Medicaid
D12116Medicare UPIN