MEDICARE: ROGER MICHAEL COURNOYER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	01096281A	IN

General Provider Information

NPI Number	:	1538664701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER MICHAEL COURNOYER MD

Provider Business Mailing Address
First Line	:	PO BOX 781076
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48278-1076
Country	:	US
Telephone Number	:	317-528-4800
Fax Number	:	317-865-1479

Provider Business Practice Location Address
First Line	:	5255 E STOP 11 RD STE 200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-6341
Country	:	US
Telephone Number	:	317-528-1212
Fax Number	:	317-528-1252

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2018
Last Update Date	:	02/12/2026

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