Provider Demographics
NPI:1194798751
Name:ROGERS, JEFFREY PHILLIP (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:PHILLIP
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12116 HWY 60
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-9335
Mailing Address - Country:US
Mailing Address - Phone:262-376-2992
Mailing Address - Fax:414-281-6522
Practice Address - Street 1:2500 W LAYTON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-5420
Practice Address - Country:US
Practice Address - Phone:414-281-3444
Practice Address - Fax:414-281-6522
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23216207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30359100Medicaid
WI73028Medicare ID - Type Unspecified
WI30359100Medicaid