Healthcare Provider Details

I. General information

NPI: 1609879675
Provider Name (Legal Business Name): STEPHEN KYLE ROGERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 LAFAYETTE RD STE 200
INDIANAPOLIS IN
46222-1147
US

IV. Provider business mailing address

3400 LAFAYETTE RD STE 200
INDIANAPOLIS IN
46222-1147
US

V. Phone/Fax

Practice location:
  • Phone: 317-291-7422
  • Fax: 317-291-7433
Mailing address:
  • Phone: 317-291-7422
  • Fax: 317-291-7433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01054781A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: