Healthcare Provider Details

I. General information

NPI: 1730576349
Provider Name (Legal Business Name): LAGONIA ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3740 CRANE ST
DETROIT MI
48214-1233
US

IV. Provider business mailing address

PO BOX 24387
NASHVILLE TN
37202-4387
US

V. Phone/Fax

Practice location:
  • Phone: 313-729-0021
  • Fax: 888-242-7469
Mailing address:
  • Phone: 877-977-4630
  • Fax: 888-242-7469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: