Healthcare Provider Details

I. General information

NPI: 1861449035
Provider Name (Legal Business Name): JOHN ANTHONY ROFFERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 E NEWPORT AVE
MILWAUKEE WI
53211-2906
US

IV. Provider business mailing address

525 W RIVER WOODS PKWY STE 240
GLENDALE WI
53212-1010
US

V. Phone/Fax

Practice location:
  • Phone: 414-961-4161
  • Fax: 414-967-1778
Mailing address:
  • Phone: 414-327-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number30078-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: