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General NPI Number Information
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NPI Number | 1053525527
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Entity Type | Individual
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Provider Name | WENDY ANN ROGOWSKI PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 1900 WEST POLK STREET
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City | CHICAGO
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State | IL
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Zip | 60612
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Country | US
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Telephone | 312-864-5204
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Fax | 312-864-9782
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Provider Business Mailing Address
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Address Line | 7201 BRADFORD COURT
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City | JUSTICE
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State | IL
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Zip | 60458
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Country | US
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Telephone | 312-864-5204
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Fax | 312-864-9782
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 385001081
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License Number State | IL
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