Provider Demographics
NPI:1689681884
Name:ROGERS, CHARLES ALFRED (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ALFRED
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 CHICAGO AVENUE SOUTH
Mailing Address - Street 2:SUITE 405
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4544
Mailing Address - Country:US
Mailing Address - Phone:612-871-5511
Mailing Address - Fax:612-871-0996
Practice Address - Street 1:2545 CHICAGO AVENUE SOUTH
Practice Address - Street 2:SUITE 405
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4544
Practice Address - Country:US
Practice Address - Phone:612-871-5511
Practice Address - Fax:612-871-0996
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20144208000000X
KS0414742208000000X
WI19438208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN00337001OtherPREFERRED ONE
MNV41130100922689OtherHEALTHPARTNERS
MN1200067OtherMEDICA HEALTH PLAN
MN0N261ROOtherBLUE CROSS BLUE SHIELD MN
MN111171OtherUCARE OF MINNESOTA
MN0N261ROOtherBLUE CROSS BLUE SHIELD MN