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General NPI Number Information
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NPI Number | 1861037277
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Entity Type | Individual
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Provider Name | MICHEAL F. ROGERS PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/08/2019
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Last Update Date | 07/27/2023
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Provider Practice Location Address
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Address Line | 6780 MAYFIELD RD
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City | MAYFIELD HEIGHTS
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State | OH
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Zip | 44124-2203
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Country | US
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Telephone | 440-312-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 5428 PINEHILL DR
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City | MENTOR ON THE LAKE
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State | OH
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Zip | 44060-1434
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Country | US
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Telephone | 440-413-7639
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Fax |
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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 | 9556
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.006232
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License Number State | OH
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