| Internal Medicine & Aesthetics | |
|
6505 Constitution Blvd Portage MI 49024-1604 | |
| (269) 599-8140 | |
| (269) 324-4329 |
| Full Name | Internal Medicine & Aesthetics |
|---|---|
| Speciality | Internal Medicine |
| Location | 6505 Constitution Blvd, Portage, Michigan |
| Authorized Official Name and Position | Julie Bergman (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 7659644100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Internal Medicine & Aesthetics Po Box 443 Union City IN 47390-0443 Ph: (765) 964-4100 | Internal Medicine & Aesthetics 6505 Constitution Blvd Portage MI 49024-1604 Ph: (269) 599-8140 |
| NPI Number | 1780442103 |
|---|---|
| Provider Enumeration Date | 03/11/2024 |
| Last Update Date | 03/11/2024 |
| Certification Date | 03/11/2024 |
| Medicare PECOS PAC ID | 1759721368 |
|---|---|
| Medicare Enrollment ID | O20240430002265 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780442103 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (NU) | Primary |
| Provider Name | Rockelle D Rogers |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962596502 PECOS PAC ID: 8123052917 Enrollment ID: I20050921000599 |
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