Individual
CASSANDRA BOGGON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16203 WYOMING ST, DETROIT, MI 48221-3417
(313) 864-2788
(866) 267-7903
Mailing address
8457 BRACE ST, DETROIT, MI 48228-3144
(734) 334-0208
(866) 267-7903
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2701115101
MI
Other
Enumeration date
06/03/2010
Last updated
06/03/2010
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