Individual
JOHN RICHARD MOGOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7128 FULTON ST E, ADA, MI 49301-8413
(616) 825-3530
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
(616) 486-6790
(616) 486-6702
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301063084
MI
208000000X
Pediatrics Physician
4301063084
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0D14849
MEDICARE RAILROAD
MI
01
—
110110939
MEDICARE RAILROAD
MI
05
—
3062947
—
MI
Enumeration date
02/21/2006
Last updated
03/26/2021
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