Organization
MOBILE PODIATRIST, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IRENE ERICA ROGE D.P.M. (PRESIDENT)
(317) 697-6536
Entity
Organization
Contact information
Practice address
1558 VICTORIA CT, GREENWOOD, IN 46143-7884
(317) 697-6536
(317) 859-2923
Mailing address
1558 VICTORIA CT, GREENWOOD, IN 46143-7884
(317) 697-6536
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
016-004848
IL
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
07001009A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE1825
RAILROAD MEDICARE
IL
01
—
DF0688
RAILROAD MEDICARE
IN
Enumeration date
07/23/2007
Last updated
06/03/2011
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