Individual
LEJU MOGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
790 FULLER AVE NE, GRAND RAPIDS, MI 49503-1918
(616) 336-3909
(616) 336-8830
Mailing address
790 FULLER AVE NE, GRAND RAPIDS, MI 49503-1918
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
M520676271002
MI
Other
Enumeration date
04/01/2026
Last updated
04/01/2026
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