Provider Demographics
NPI:1861434136
Name:JORAM O MOGAKA MD PC
Entity type:Organization
Organization Name:JORAM O MOGAKA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORAM
Authorized Official - Middle Name:O
Authorized Official - Last Name:MOGAKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:586-944-2131
Mailing Address - Street 1:25959 KELLY RD STE A
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4991
Mailing Address - Country:US
Mailing Address - Phone:586-944-2131
Mailing Address - Fax:586-842-3728
Practice Address - Street 1:25959 KELLY RD STE A
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4991
Practice Address - Country:US
Practice Address - Phone:586-944-2131
Practice Address - Fax:586-842-3728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1108235572OtherBLUE CROSS BLUE SHIELD
MI1861434136OtherGROUP NPI
MI1255407631OtherINDIVUDAL NPI NUMBER
MI700H271450OtherUNITED FAMILY BC
MI1205126216OtherUNITED FAMILY GR
MI472234510Medicaid
MIMI4577Medicare PIN
MI1861434136OtherGROUP NPI
MI0P15370Medicare PIN