Healthcare Provider Details

I. General information

NPI: 1902311525
Provider Name (Legal Business Name): GURMEET KAUR GOGIA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 JOHN R ST STE 1021
DETROIT MI
48201-2017
US

IV. Provider business mailing address

4160 JOHN R ST STE 1021
DETROIT MI
48201-2017
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-9853
  • Fax: 313-745-8222
Mailing address:
  • Phone: 313-966-9853
  • Fax: 313-745-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704288364
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: