MEDICARE: HIKMAT P GOGUE M.D.

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	2080A0000X	Pediatric Adolescent Medicine Physician	4301044392	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821066697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HIKMAT P GOGUE M.D.

Provider Business Mailing Address
First Line	:	3352 CIRCLE DR
Second Line	:
City	:	COMMERCE
State	:	MI
Zip	:	48382-1957
Country	:	US
Telephone Number	:	586-446-8060
Fax Number	:

Provider Business Practice Location Address
First Line	:	39242 DEQUINDRE RD
Second Line	:	SUITE 101
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	:	03/09/2006
Last Update Date	:	04/13/2016

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