Provider Demographics
NPI:1649027822
Name:ROGER, DOUNI ONESIPHORE NGOUNOU (MD)
Entity type:Individual
Prefix:
First Name:DOUNI
Middle Name:ONESIPHORE NGOUNOU
Last Name:ROGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:TAKOUTSING
Other - Middle Name:
Other - Last Name:ONESIPHORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:727 EL CRESTON CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-3231
Mailing Address - Country:US
Mailing Address - Phone:214-554-4904
Mailing Address - Fax:
Practice Address - Street 1:1215 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1811
Practice Address - Country:US
Practice Address - Phone:517-364-2583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-04
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program