Healthcare Provider Details

I. General information

NPI: 1649027822
Provider Name (Legal Business Name): DOUNI ONESIPHORE NGOUNOU ROGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. TAKOUTSING ONESIPHORE

II. Dates (important events)

Enumeration Date: 05/04/2024
Last Update Date: 05/04/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1811
US

IV. Provider business mailing address

727 EL CRESTON CIR
LAS VEGAS NM
87701-3231
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-2583
  • Fax:
Mailing address:
  • Phone: 214-554-4904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: