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General NPI Number Information
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NPI Number | 1356151351
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Entity Type | Organization
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Legal Business Name | MEDINFUSE PLLC
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Dates
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Enumeration Date | 01/10/2025
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 20000 W 12 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2428
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Country | US
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Telephone | 248-561-4812
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Fax |
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Provider Business Mailing Address
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Address Line | 4612 RIVERS EDGE DR
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City | TROY
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State | MI
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Zip | 48098-4160
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Country | US
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Telephone | 248-561-4812
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. PAUL GOGUE
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Credential | MD
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Telephone | 248-561-4812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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