MEDICARE: OLLIE ROGERS

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
1	363LF0000X	Family Nurse Practitioner	209004634	IL

General Provider Information

NPI Number	:	1912022450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLLIE ROGERS

Provider Business Mailing Address
First Line	:	8909 SILVERDALE DR
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-3380
Country	:	US
Telephone Number	:	779-243-8785
Fax Number	:

Provider Business Practice Location Address
First Line	:	1969 W OGDEN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3765
Country	:	US
Telephone Number	:	312-864-0200
Fax Number	:	484-351-3800

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	06/20/2024

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Directions to “ OLLIE ROGERS ” Practice Location

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