Provider Demographics
NPI:1629079728
Name:LAGROU, SUSAN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ANN
Last Name:LAGROU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1349 S ROCHESTER RD
Mailing Address - Street 2:STE 215
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3150
Mailing Address - Country:US
Mailing Address - Phone:248-652-3300
Mailing Address - Fax:248-652-3175
Practice Address - Street 1:1349 S ROCHESTER RD
Practice Address - Street 2:STE 215
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-3150
Practice Address - Country:US
Practice Address - Phone:248-652-3300
Practice Address - Fax:248-652-3175
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068132208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H05452Medicare UPIN