Provider Demographics
NPI:1760699979
Name:RITA D ROGERS
Entity Type:Organization
Organization Name:RITA D ROGERS
Other - Org Name:SERENITY PHYSICIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-429-3164
Mailing Address - Street 1:1009 DREXEL ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1639
Mailing Address - Country:US
Mailing Address - Phone:313-429-3164
Mailing Address - Fax:313-429-3165
Practice Address - Street 1:1009 DREXEL ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-1639
Practice Address - Country:US
Practice Address - Phone:313-429-3164
Practice Address - Fax:313-429-3165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty