Provider Demographics
NPI:1497762819
Name:ROGE, IRENE ERICA (DPM)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:ERICA
Last Name:ROGE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1558 VICTORIA CT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7884
Mailing Address - Country:US
Mailing Address - Phone:317-697-6536
Mailing Address - Fax:317-859-2923
Practice Address - Street 1:1558 VICTORIA CT
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-7884
Practice Address - Country:US
Practice Address - Phone:317-697-6536
Practice Address - Fax:317-859-2923
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001009A213E00000X
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00276788OtherRAILROAD MEDICARE
INP00336058OtherRAILROAD MEDICARE
INP00336058OtherRAILROAD MEDICARE
ILK24402Medicare PIN