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NPI Code Detail

MEDICARE: JOHN RICHARD MOGOR M.D.

MEDICARE: JOHN RICHARD MOGOR M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician4301063084MI
2207R00000XInternal Medicine Physician4301063084MI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2110110939OTHERMIMEDICARE RAILROAD
30D14849OTHERMIMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518932839
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN RICHARD MOGOR M.D.
Provider Business Mailing Address
First Line : 100 MICHIGAN ST NE # MC845
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-2560
Country : US
Telephone Number : 616-486-6790
Fax Number : 616-486-6702
Provider Business Practice Location Address
First Line : 7128 FULTON ST E
Second Line :
City : ADA
State : MI
Zip : 49301-8413
Country : US
Telephone Number : 616-825-3530
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2006
Last Update Date : 03/26/2021

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Directions to “ JOHN RICHARD MOGOR M.D.” Practice Location

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