MEDICARE: MARK ROGER RAFFIN

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	2251X0800X	Orthopedic Physical Therapist	5501011264	MI

General Provider Information

NPI Number	:	1639275092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ROGER RAFFIN

Provider Business Mailing Address
First Line	:	1340 E FAIRVIEW LN
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48306-4128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	54945 MOUND RD
Second Line	:
City	:	SHELBY TWP
State	:	MI
Zip	:	48316
Country	:	US
Telephone Number	:	586-992-1500
Fax Number	:	586-992-8050

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/08/2007

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Directions to “ MARK ROGER RAFFIN ” Practice Location

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