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General NPI Number Information
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NPI Number | 1487879797
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Entity Type | Organization
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Legal Business Name | GARY J ROGERS DPM PC
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 09/18/2014
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Provider Practice Location Address
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Address Line | 1919 LAKE AVE STE A
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City | WILMETTE
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State | IL
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Zip | 60091-1422
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Country | US
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Telephone | 847-256-4434
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Fax | 847-256-4437
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Provider Business Mailing Address
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Address Line | 1919 LAKE AVE STE A
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City | WILMETTE
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State | IL
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Zip | 60091-1422
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Country | US
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Telephone | 847-256-4434
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Fax | 847-256-4437
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Authorized Official
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Title or Position | OWNER
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Name | GARY ROGERS
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Credential | DPM
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Telephone | 847-256-4434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016004888
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License Number State | IL
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