Individual
ROGER B FENTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
27379 DEQUINDRE, MADISON HEIGHTS, MI 48071
(248) 398-4488
(248) 398-4995
Mailing address
4996 CHAMPLAIN CIRCLE, WEST BLOOMFIELD, MI 48323
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
5101006368
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200F311140
BCBSM
MI
05
—
2768532
—
MI
Enumeration date
08/14/2006
Last updated
06/14/2011
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