Provider Demographics
NPI:1750134268
Name:ROGERS, DEMETRIUS DEQUAN
Entity type:Individual
Prefix:
First Name:DEMETRIUS
Middle Name:DEQUAN
Last Name:ROGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3097 CORNERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2389
Mailing Address - Country:US
Mailing Address - Phone:313-687-3236
Mailing Address - Fax:
Practice Address - Street 1:3097 CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2389
Practice Address - Country:US
Practice Address - Phone:313-687-3236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant