Provider Demographics
NPI:1689454712
Name:ROGERS, ANDRE DESHAWN SR
Entity Type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:DESHAWN
Last Name:ROGERS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10255 STORM DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-1255
Mailing Address - Country:US
Mailing Address - Phone:513-400-9111
Mailing Address - Fax:
Practice Address - Street 1:7373 BROOKCREST DR STE 354
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-3448
Practice Address - Country:US
Practice Address - Phone:513-802-5642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator