Individual
ROGER MAILLEFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14695 PARK AVE STE A, CHARLEVOIX, MI 49720-1920
(231) 547-2812
Mailing address
14695 PARK AVE, STE A, CHARLEVOIX, MI 49720-1920
(815) 758-8671
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036-098042
IL
208600000X
Surgery Physician
Primary
4301503936
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036098042
—
IL
01
—
040142
HEALTH ALLIANCE
IL
Enumeration date
08/13/2006
Last updated
12/12/2025
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