Provider Demographics
NPI:1548269574
Name:TRUE, ROGER A (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:A
Last Name:TRUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7625 SUMMERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9677
Mailing Address - Country:US
Mailing Address - Phone:734-854-7625
Mailing Address - Fax:734-854-7625
Practice Address - Street 1:7625 SUMMERFIELD RD
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9677
Practice Address - Country:US
Practice Address - Phone:734-854-7625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044349207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI00743OtherPARAMOUNT
MI3315952Medicaid
OH0471921Medicaid
MI080E810120OtherBCBS MI
MI4002615OtherAETNA
MI000000147095OtherANTHEM
MI01-03231OtherUHC
MI080102492OtherRRMC
MI080102492OtherRRMC
MIB45601Medicare UPIN
MI3315952Medicaid