Mogaka, Joram O
Mogaka, Joram O is an sole proprietor health care provider with primary practice located at 22631 Greater Mack Ave , Saint Clair Shores MI 48080-2055. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Mogaka, Joram O can be contacted via phone (586) 771-0100.Contact Information
Primary practice address
22631 Greater Mack Ave
Saint Clair Shores MI 48080-2055
Phone: (586) 771-0100
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 076566 | Michigan |
Profile Details
| NPI number | 1255407631 |
|---|---|
| LBN Legal business name | Mogaka, Joram O |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 28th, 2006 |
| Last updated | Aug 18th, 2015 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1255407631 | NPPES |
| Michigan | Other | 810666394 | TAX ID |
| Michigan | Other | 1108235572 | TAX ID |
| Michigan | MEDICAID | 472234510 | TAX ID |
| Michigan | Other | 1106314802 | TAX ID |
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