Healthcare Provider Details

I. General information

NPI: 1811564354
Provider Name (Legal Business Name): EMILY L HOGLUND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6821 MEDBURY ST
DETROIT MI
48211-3317
US

IV. Provider business mailing address

674 E GRAND BLVD
DETROIT MI
48207-2526
US

V. Phone/Fax

Practice location:
  • Phone: 313-922-2222
  • Fax: 866-287-5710
Mailing address:
  • Phone: 313-452-2293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: