Provider Demographics
NPI:1932365947
Name:ROGOWSKI, BRAD R (DO)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:R
Last Name:ROGOWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:IL
Mailing Address - Zip Code:61342-2123
Mailing Address - Country:US
Mailing Address - Phone:815-538-5011
Mailing Address - Fax:
Practice Address - Street 1:600 E 1ST ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61362-1512
Practice Address - Country:US
Practice Address - Phone:815-223-1464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.119824207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine