Provider Demographics
NPI:1992992820
Name:ROGERS MEDICAL, LTD
Entity type:Organization
Organization Name:ROGERS MEDICAL, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:PECHEREK ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-436-9393
Mailing Address - Street 1:24012 W RENWICK RD
Mailing Address - Street 2:14 & 15
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-8731
Mailing Address - Country:US
Mailing Address - Phone:815-436-9393
Mailing Address - Fax:815-436-9393
Practice Address - Street 1:24012 W RENWICK RD
Practice Address - Street 2:14 & 15
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-8731
Practice Address - Country:US
Practice Address - Phone:815-436-9393
Practice Address - Fax:815-436-9393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103443207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID