MEDICARE: CAROL L ROGE MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	24959	IA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	47516	OTHER	IA	WELLMARK BCBS
2	20082	OTHER		SIOUX VALLEY
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	75305796351104A002	OTHER		TRICARE
5	9182435	OTHER		DAKOTA CERE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	3879	OTHER		MIDLANDS CHOICE

NPI Number	:	1295794402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL L ROGE MD

Provider Business Mailing Address
First Line	:	814 PIERCE ST
Second Line	:	SUITE 102
City	:	SIOUX CITY
State	:	IA
Zip	:	51101-1058
Country	:	US
Telephone Number	:	712-226-2600
Fax Number	:	712-226-2605

Provider Business Practice Location Address
First Line	:	4230 HAMILTON BLVD
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-1137
Country	:	US
Telephone Number	:	712-239-4900
Fax Number	:	712-239-2866

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	02/07/2011

2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106

Practice Phone: 605-373-0100
Practice Fax: