Provider Demographics
NPI:1699732677
Name:MOGERMAN, JOHN STEVEN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:STEVEN
Last Name:MOGERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:DEPARTMENT 272801
Mailing Address - Street 2:PO BOX 67000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-0001
Mailing Address - Country:US
Mailing Address - Phone:517-841-6913
Mailing Address - Fax:517-841-6917
Practice Address - Street 1:205 N EAST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1753
Practice Address - Country:US
Practice Address - Phone:517-788-4730
Practice Address - Fax:517-788-4701
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43014058872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF31032Medicare UPIN
MIC86389004Medicare ID - Type UnspecifiedWA FOOTE MEMORIAL