Provider Demographics
NPI:1013953165
Name:KATHRYN EISERMANN ROGERS MD PA
Entity Type:Organization
Organization Name:KATHRYN EISERMANN ROGERS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:EISERMANN-ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-665-1623
Mailing Address - Street 1:6705 SW 57TH AVE
Mailing Address - Street 2:SUITE 318
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3638
Mailing Address - Country:US
Mailing Address - Phone:305-665-1623
Mailing Address - Fax:305-666-9176
Practice Address - Street 1:6705 SW 57TH AVE
Practice Address - Street 2:SUITE 318
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33143-3638
Practice Address - Country:US
Practice Address - Phone:305-665-1623
Practice Address - Fax:305-666-9176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33277OtherBLUE CROSS BLUE SHIELD
FL33277AMedicare PIN
FL33277OtherBLUE CROSS BLUE SHIELD