MEDICARE: RANA GOGUE PA-C

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	363A00000X	Physician Assistant	5601006685	MI

General Provider Information

NPI Number	:	1750728515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANA GOGUE PA-C

Provider Business Mailing Address
First Line	:	39242 DEQUINDRE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-1764
Country	:	US
Telephone Number	:	586-747-0463
Fax Number	:

Provider Business Practice Location Address
First Line	:	39242 DEQUINDRE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-1764
Country	:	US
Telephone Number	:	586-446-8060
Fax Number	:

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

Provider Enumeration Date	:	06/03/2013
Last Update Date	:	11/07/2017

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