Basic Information
Provider Information | |||||||||
NPI: | 1699843797 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ROGERS | ||||||||
FirstName: | FELIX | ||||||||
MiddleName: | J | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1640 FORT ST | ||||||||
Address2: | SUITE D ATTN DENISE | ||||||||
City: | TRENTON | ||||||||
State: | MI | ||||||||
PostalCode: | 481832040 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7343913057 | ||||||||
FaxNumber: | 7343913052 | ||||||||
Practice Location | |||||||||
Address1: | 23050 WEST RD | ||||||||
Address2: | SUOTE 120 | ||||||||
City: | BROWNSTOWN TWP | ||||||||
State: | MI | ||||||||
PostalCode: | 481831472 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7346711510 | ||||||||
FaxNumber: | 7346711570 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/30/2006 | ||||||||
LastUpdateDate: | 02/22/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5101006707 | MI | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RC0000X | 5101006707 | MI | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 5101006707 | MI | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
ID | Type | State | Issuer | Description | 0H27585 | 01 | MI | BLUE CROSS | OTHER | 1700145851 | 01 | MI | GROUP NPI HENRY FORD WYANDOTTE | OTHER | 129581411 | 05 | MI |   | MEDICAID |