MEDICARE: MRS. GURMEET KAUR GOGIA FNP-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	363LF0000X	Family Nurse Practitioner	4704288364	MI

General Provider Information

NPI Number	:	1902311525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GURMEET KAUR GOGIA FNP-C

Provider Business Mailing Address
First Line	:	4160 JOHN R ST STE 1021
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-2017
Country	:	US
Telephone Number	:	313-966-9853
Fax Number	:	313-745-8222

Provider Business Practice Location Address
First Line	:	4160 JOHN R ST STE 1021
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-2017
Country	:	US
Telephone Number	:	313-966-9853
Fax Number	:	313-745-8222

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

Provider Enumeration Date	:	12/05/2017
Last Update Date	:	08/27/2020

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Directions to “ MRS. GURMEET KAUR GOGIA FNP-C” Practice Location

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