Provider Demographics
NPI:1386838498
Name:ROGER, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:ROGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 N. MIAMI AVE.
Mailing Address - Street 2:
Mailing Address - City:BISCAYNE GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33168
Mailing Address - Country:US
Mailing Address - Phone:305-528-7044
Mailing Address - Fax:
Practice Address - Street 1:13780 N MIAMI AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-4830
Practice Address - Country:US
Practice Address - Phone:305-528-7044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNTF 1006-7450-06171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor