Individual
DR. JORAM O MOGAKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
22631 GREATER MACK AVE, SAINT CLAIR SHORES, MI 48080-2055
(586) 771-0100
Mailing address
4967 CROOKS RD, STE 130, TROY, MI 48098-5801
(248) 952-1601
(248) 952-1614
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
076566
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1106314802
BLUE CARE NETWORK
MI
01
—
1108235572
BLUE CROSS BLUE SHIELD
MI
05
—
472234510
—
MI
01
—
810666394
TAX ID
MI
Enumeration date
11/28/2006
Last updated
08/18/2015
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