Healthcare Provider Details

I. General information

NPI: 1841306180
Provider Name (Legal Business Name): ROGER ABIRAGI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RAGI ABIRAGI M.D.

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35054 23 MILE RD 101
NEW BALTIMORE MI
48047-2019
US

IV. Provider business mailing address

35054 23 MILE RD 101
NEW BALTIMORE MI
48047-2019
US

V. Phone/Fax

Practice location:
  • Phone: 586-725-2670
  • Fax: 586-725-3347
Mailing address:
  • Phone: 586-725-2670
  • Fax: 586-725-3347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301040525
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: