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1649219734

NPI Code Detail

MEDICARE: NJIRA LUCIA LUGOGO M.D.

MEDICARE: NJIRA LUCIA LUGOGO 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
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	200201490	NC
2	207RP1001X	Pulmonary Disease Physician	4301111896	MI
3	207R00000X	Internal Medicine Physician	2002-01490	NC
4	207R00000X	Internal Medicine Physician	4301000896	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2002-01490	OTHER	NC	MEDICAL LICENSE

General Provider Information

NPI Number	:	1649219734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NJIRA LUCIA LUGOGO M.D.

Provider Business Mailing Address
First Line	:	3621 S STATE ST
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48108-1633
Country	:	US
Telephone Number	:	734-647-5299
Fax Number	:

Provider Business Practice Location Address
First Line	:	380 PARKLAND PLZ
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-6201
Country	:	US
Telephone Number	:	734-615-3217
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	05/10/2021

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Directions to “ NJIRA LUCIA LUGOGO M.D.” Practice Location

Language	Start Address	Practice Location

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