Individual
DR. RIYAZUDDIN S MOGALAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
430 E DIVISION ST, FOND DU LAC, WI 54935-4560
(260) 266-2020
(260) 266-2009
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
(920) 926-8370
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
63783
WI
208M00000X
Hospitalist Physician
Primary
63783
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000628125
ANTHEM PROVIDER NUMBER
IN
01
—
000000748342
ANTHEM
IN
05
—
0060603
—
OH
05
—
200972310
—
IN
01
—
P01040162
RR MEDICARE
IN
Enumeration date
08/18/2008
Last updated
11/19/2020
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