Provider Demographics
NPI:1861835365
Name:ROGERS, KEISHA DENISE (MD)
Entity type:Individual
Prefix:DR
First Name:KEISHA
Middle Name:DENISE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KEISHA
Other - Middle Name:DENISE
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11211 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-1035
Mailing Address - Country:US
Mailing Address - Phone:414-454-8300
Mailing Address - Fax:414-327-1450
Practice Address - Street 1:11211 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1035
Practice Address - Country:US
Practice Address - Phone:414-454-8300
Practice Address - Fax:414-327-1450
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63358207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine