Provider Demographics
NPI:1316903347
Name:ROGERS, BERTRAM HENRY GERALD (MD)
Entity type:Individual
Prefix:DR
First Name:BERTRAM
Middle Name:HENRY GERALD
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:505 NORTH LAKE SHORE DR
Mailing Address - Street 2:SUITE 406
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3493
Mailing Address - Country:US
Mailing Address - Phone:312-828-9747
Mailing Address - Fax:312-828-9761
Practice Address - Street 1:505 NORTH LAKE SHORE DR
Practice Address - Street 2:SUITE 406
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3493
Practice Address - Country:US
Practice Address - Phone:312-828-9747
Practice Address - Fax:312-828-9761
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03604176Medicaid
IL453570Medicare ID - Type Unspecified
ILD12116Medicare UPIN