Healthcare Provider Details

I. General information

NPI: 1760699979
Provider Name (Legal Business Name): RITA D ROGERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 DREXEL ST
DEARBORN MI
48128-1639
US

IV. Provider business mailing address

1009 DREXEL ST
DEARBORN MI
48128-1639
US

V. Phone/Fax

Practice location:
  • Phone: 313-429-3164
  • Fax: 313-429-3165
Mailing address:
  • Phone: 313-429-3164
  • Fax: 313-429-3165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number State

VIII. Authorized Official

Name: RITA D ROGERS
Title or Position: CEO
Credential:
Phone: 313-429-3164