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General NPI Number Information
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NPI Number | 1558373696
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Entity Type | Individual
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Provider Name | ROGER MAILLEFER M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 14695 PARK AVE STE A
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City | CHARLEVOIX
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State | MI
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Zip | 49720-1920
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Country | US
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Telephone | 231-547-2812
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Fax |
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Provider Business Mailing Address
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Address Line | 14695 PARK AVE STE A
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City | CHARLEVOIX
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State | MI
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Zip | 49720-1920
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Country | US
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Telephone | 815-758-8671
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301503936
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036-098042
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License Number State | IL
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