Organization
OCTAVETIEN ROGERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OCTAVETIEN ROGERS (CEO)
(313) 914-2102
Entity
Organization
Contact information
Practice address
221 N SILVERY LN, DEARBORN, MI 48128-1593
(313) 914-2102
Mailing address
221 N SILVERY LN, DEARBORN, MI 48128-1593
(313) 914-2102
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
699577
MI
Other
Enumeration date
11/14/2008
Last updated
04/29/2009
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