MEDICARE: KENNETH H ROGOTZKE DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	30237	MN
2	207Y00000X	Otolaryngology Physician	1768	SD
3	207Y00000X	Otolaryngology Physician	0102203300	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275539132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH H ROGOTZKE DO

Provider Business Mailing Address
First Line	:	2900 LAMB CIR
Second Line	:
City	:	CHRISTIANSBURG
State	:	VA
Zip	:	24073-6344
Country	:	US
Telephone Number	:	540-731-7600
Fax Number	:	540-633-0125

Provider Business Practice Location Address
First Line	:	2900 LAMB CIR
Second Line	:
City	:	CHRISTIANSBURG
State	:	VA
Zip	:	24073-6344
Country	:	US
Telephone Number	:	540-731-7600
Fax Number	:	540-633-0125

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	12/08/2020

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