MEDICARE: ROGER TRAVIS DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	PO 3865	FL
2	213E00000X	Podiatrist	PO 3865	FL

General Provider Information

NPI Number	:	1619165420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER TRAVIS DPM

Provider Business Mailing Address
First Line	:	2424 ROCHESTER RD
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-3633
Country	:	US
Telephone Number	:	434-250-4862
Fax Number	:

Provider Business Practice Location Address
First Line	:	27351 DEQUINDRE RD
Second Line	:
City	:	MADISON HTS
State	:	MI
Zip	:	48071-3487
Country	:	US
Telephone Number	:	248-967-7795
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	01/09/2017

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Directions to “ ROGER TRAVIS DPM” Practice Location

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