Basic Information
| Provider Information | |||||||||
| NPI: | 1336139443 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOGINENI | ||||||||
| FirstName: | MADHURI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 W 18TH ST | ||||||||
| Address2: | 5A | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100114624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3219611181 | ||||||||
| FaxNumber: | 6463296397 | ||||||||
| Practice Location | |||||||||
| Address1: | 748 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CHEBOYGAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497212220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2316271438 | ||||||||
| FaxNumber: | 2316271471 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME89139 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.