Healthcare Provider Details

I. General information

NPI: 1336865112
Provider Name (Legal Business Name): TOVA ROGERS MD MFA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 BRIDGE ST
CHARLEVOIX MI
49720-2603
US

IV. Provider business mailing address

1404 BRIDGE ST
CHARLEVOIX MI
49720-2603
US

V. Phone/Fax

Practice location:
  • Phone: 231-497-1272
  • Fax: 248-780-6936
Mailing address:
  • Phone: 248-894-0196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TOVA ROGERS
Title or Position: OWNER
Credential: MD
Phone: 248-894-0196