Individual
JOHNENE K KOGANTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., PA-C
Contact information
Practice address
3901 BEAUBIEN ST, ANESTHESIOLOGY DEPARTMENT (PAIN CLINIC), DETROIT, MI 48201-2119
(248) 376-4016
Mailing address
1270 DORCHESTER AVE, BLOOMFIELD, MI 48302-0019
(248) 376-4016
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601005495
MI
Other
Enumeration date
07/22/2009
Last updated
07/22/2009
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