Provider Demographics
NPI:1891863999
Name:ROGERS, JOSEPH C (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1640 FORT ST
Mailing Address - Street 2:SUITE D ATTN DENISE
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2040
Mailing Address - Country:US
Mailing Address - Phone:734-391-3057
Mailing Address - Fax:734-391-3052
Practice Address - Street 1:23050 WEST RD
Practice Address - Street 2:STE 120
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1472
Practice Address - Country:US
Practice Address - Phone:734-671-1510
Practice Address - Fax:734-671-1570
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2017-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101006290207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI334280611Medicaid
1700145851OtherGROUP NPI HENRY FORD WYANDOTTE
MI0H27585OtherBLUE CROSS
MIMI5976003Medicare PIN
MI0H27585OtherBLUE CROSS
0H26441047Medicare ID - Type Unspecified