Healthcare Provider Details

I. General information

NPI: 1548269574
Provider Name (Legal Business Name): ROGER A TRUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7625 SUMMERFIELD RD
LAMBERTVILLE MI
48144-9677
US

IV. Provider business mailing address

7625 SUMMERFIELD RD
LAMBERTVILLE MI
48144-9677
US

V. Phone/Fax

Practice location:
  • Phone: 734-854-7625
  • Fax:
Mailing address:
  • Phone: 734-854-7625
  • Fax: 734-854-7625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301044349
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: