Provider Demographics
NPI:1700934544
Name:HUGHES, ROGER (MA IN AUDIOLOGY)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:
Last Name:HUGHES
Suffix:
Gender:M
Credentials:MA IN AUDIOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 BELLE CHASE WAY
Mailing Address - Street 2:SUITE 700
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4274
Mailing Address - Country:US
Mailing Address - Phone:517-887-7660
Mailing Address - Fax:517-887-7661
Practice Address - Street 1:3410 BELLE CHASE WAY
Practice Address - Street 2:SUITE 700
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4274
Practice Address - Country:US
Practice Address - Phone:517-887-7660
Practice Address - Fax:517-887-7661
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000104231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4683710Medicaid
MI4684351Medicaid
MI200000000506OtherPHPMM
MI640C312830OtherBCBSM
MI4683710Medicaid