Provider Demographics
NPI:1720108137
Name:ROGER F. CLASSEN, D.O., INC.
Entity Type:Organization
Organization Name:ROGER F. CLASSEN, D.O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:F
Authorized Official - Last Name:CLASSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:216-561-0111
Mailing Address - Street 1:4100 WARRENSVILLE CENTER RD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7024
Mailing Address - Country:US
Mailing Address - Phone:216-561-0111
Mailing Address - Fax:216-561-0113
Practice Address - Street 1:4100 WARRENSVILLE CENTER RD
Practice Address - Street 2:SUITE #101
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-7024
Practice Address - Country:US
Practice Address - Phone:216-561-0111
Practice Address - Fax:216-561-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-2162208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9175381OtherMEDICARE PTAN GROUP
OH0335140Medicaid
OHA76129Medicare UPIN
OH9175381Medicare PIN