Individual
LISA R ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
2333 BIDDLE AVE, WYANDOTTE, MI 48192-4668
(313) 916-2723
Mailing address
1 FORD PL STE 2E, DETROIT, MI 48202-3450
(313) 874-4806
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
34.003427
OH
2084N0400X
Neurology Physician
Primary
5101011925
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0569157
—
OH
05
—
4850149
—
MI
01
—
P00880297
RR MEDICARE
OH
Enumeration date
10/17/2006
Last updated
11/19/2021
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