Provider Demographics
NPI:1962437756
Name:ROGERS, SUSAN FRANCES (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:FRANCES
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 W POLK ST
Mailing Address - Street 2:#1469
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3723
Mailing Address - Country:US
Mailing Address - Phone:312-864-7323
Mailing Address - Fax:312-864-9621
Practice Address - Street 1:1900 W POLK ST
Practice Address - Street 2:#1469
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3723
Practice Address - Country:US
Practice Address - Phone:312-864-7323
Practice Address - Fax:312-864-9621
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-062052208M00000X
IL036062052207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD15970Medicare UPIN