MEDICARE: MADHURI GOGINENI MD

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	207R00000X	Internal Medicine Physician	ME89139	FL

General Provider Information

NPI Number	:	1336139443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADHURI GOGINENI MD

Provider Business Mailing Address
First Line	:	15 W 18TH ST
Second Line	:	5A
City	:	NEW YORK
State	:	NY
Zip	:	10011-4624
Country	:	US
Telephone Number	:	321-961-1181
Fax Number	:	646-329-6397

Provider Business Practice Location Address
First Line	:	748 S MAIN ST
Second Line	:
City	:	CHEBOYGAN
State	:	MI
Zip	:	49721-2220
Country	:	US
Telephone Number	:	231-627-1438
Fax Number	:	231-627-1471

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

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	07/08/2007

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