MEDICARE: LAGONIA ROGERS

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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1730576349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAGONIA ROGERS

Provider Business Mailing Address
First Line	:	47352 CHERRY VALLEY DR
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48044-5904
Country	:	US
Telephone Number	:	313-729-0021
Fax Number	:

Provider Business Practice Location Address
First Line	:	11451 LAKEPOINTE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48224-1607
Country	:	US
Telephone Number	:	313-729-0021
Fax Number	:	888-242-7469

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

Provider Enumeration Date	:	04/21/2015
Last Update Date	:	06/10/2026

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Directions to “ LAGONIA ROGERS ” Practice Location

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