MEDICARE: RITA D ROGERS

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	170100000X	Ph.D. Medical Genetics

General Provider Information

NPI Number	:	1760699979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RITA D ROGERS

Provider Business Mailing Address
First Line	:	1009 DREXEL ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48128-1639
Country	:	US
Telephone Number	:	313-429-3164
Fax Number	:	313-429-3165

Provider Business Practice Location Address
First Line	:	1009 DREXEL ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48128-1639
Country	:	US
Telephone Number	:	313-429-3164
Fax Number	:	313-429-3165

Authorized Official
Title or Position	:	CEO
Name	:	RITA D ROGERS
Credential	:
Telephone Number	:	313-429-3164

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	08/22/2020

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