Provider Demographics
NPI:1336355833
Name:ROGNON, JONI LYNN (DO)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:LYNN
Last Name:ROGNON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1648 INDIAN WAY
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2246
Mailing Address - Country:US
Mailing Address - Phone:517-896-8693
Mailing Address - Fax:517-337-1778
Practice Address - Street 1:1760 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6732
Practice Address - Country:US
Practice Address - Phone:517-896-8693
Practice Address - Fax:517-337-1778
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101015197208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N41460Medicare ID - Type Unspecified