Individual
KIRSTEN I MOGBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2799 W. GRAND BLVD., DETROIT, MI 48202
(214) 645-9729
(214) 645-9289
Mailing address
2799 W. GRAND BLVD., DETROIT, MI 48202
(313) 916-7425
(313) 916-7925
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301059222
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118182804
—
TX
Enumeration date
04/12/2006
Last updated
03/25/2014
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