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NPI Code Detail

MEDICARE: KENDRIA E. HOLT-ROGERS M.D.

MEDICARE: KENDRIA E. HOLT-ROGERS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician20682MS
2207R00000XInternal Medicine Physician204882LA
3207R00000XInternal Medicine PhysicianMD.204882LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558572446
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENDRIA E. HOLT-ROGERS M.D.
Provider Business Mailing Address
First Line : 1395 NW 167TH ST
Second Line :
City : MIAMI GARDENS
State : FL
Zip : 33169-5710
Country : US
Telephone Number : 504-393-4376
Fax Number :
Provider Business Practice Location Address
First Line : 501 LAPALCO BLVD
Second Line :
City : GRETNA
State : LA
Zip : 70056-7336
Country : US
Telephone Number : 504-393-4376
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2007
Last Update Date : 03/20/2020

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