Provider Demographics
NPI:1275580656
Name:JOHN A. ROFFERS, M.D., S.C.
Entity Type:Organization
Organization Name:JOHN A. ROFFERS, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROFFERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-961-4161
Mailing Address - Street 1:2015 E NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2984
Mailing Address - Country:US
Mailing Address - Phone:414-961-4161
Mailing Address - Fax:414-967-1778
Practice Address - Street 1:2015 E NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-2984
Practice Address - Country:US
Practice Address - Phone:414-961-4161
Practice Address - Fax:414-967-1778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000046066Medicare PIN
WI000002439Medicare PIN