Provider Demographics
NPI:1386993509
Name:ROGERS, STEVEN ROBERT (PA-C)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ROBERT
Last Name:ROGERS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25425 WALDORF ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-5737
Mailing Address - Country:US
Mailing Address - Phone:586-863-6703
Mailing Address - Fax:
Practice Address - Street 1:18263 E 10 MILE RD STE D
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-5805
Practice Address - Country:US
Practice Address - Phone:586-778-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006456363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical