Healthcare Provider Details

I. General information

NPI: 1124381934
Provider Name (Legal Business Name): RYAN J ROGERS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 05/18/2025
Certification Date: 05/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32743 23 MILE RD STE 110
CHESTERFIELD MI
48047-2082
US

IV. Provider business mailing address

9400 S CICERO AVE STE 100
OAK LAWN IL
60453-2536
US

V. Phone/Fax

Practice location:
  • Phone: 586-725-3444
  • Fax: 586-725-0984
Mailing address:
  • Phone: 708-424-3201
  • Fax: 708-424-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002444
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: