| Joram O Mogaka Md Pc | |
|
21409 Kelly Rd Suite 400 Eastpointe MI 48021-3264 | |
| (586) 777-0630 | |
| (586) 777-0631 |
| Full Name | Joram O Mogaka Md Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 21409 Kelly Rd, Eastpointe, Michigan |
| Authorized Official Name and Position | Joram O Mogaka (OWNER) |
| Authorized Official Contact | 5867770630 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Joram O Mogaka Md Pc 21409 Kelly Rd Suite 400 Eastpointe MI 48021-3264 Ph: (586) 777-0630 | Joram O Mogaka Md Pc 21409 Kelly Rd Suite 400 Eastpointe MI 48021-3264 Ph: (586) 777-0630 |
| NPI Number | 1861434136 |
|---|---|
| Provider Enumeration Date | 06/12/2006 |
| Last Update Date | 11/10/2011 |
| Medicare PECOS PAC ID | 7416997606 |
|---|---|
| Medicare Enrollment ID | O20050506000412 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861434136 | NPI | - | NPPES |
| 1255407631 | Other | MI | INDIVUDAL NPI NUMBER |
| 1108235572 | Other | MI | BLUE CROSS BLUE SHIELD |
| 1205126216 | Other | MI | UNITED FAMILY GR |
| 1861434136 | Other | MI | GROUP NPI |
| 472234510 | Medicaid | MI | |
| 700H271450 | Other | MI | UNITED FAMILY BC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Joram O Mogaka |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255407631 PECOS PAC ID: 8820044738 Enrollment ID: I20050328000123 |
| Provider Name | Mohammad F Sunbulli |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841571544 PECOS PAC ID: 6507011525 Enrollment ID: I20130225000022 |
| Provider Name | Temitope Olagbaiye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043561277 PECOS PAC ID: 4789829151 Enrollment ID: I20130408000198 |
| Provider Name | Sharon A Atwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922422641 PECOS PAC ID: 1254563844 Enrollment ID: I20140414001450 |
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