Provider Demographics
NPI:1053306886
Name:NGOYI, BRIGITTE MASENGU (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIGITTE
Middle Name:MASENGU
Last Name:NGOYI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRIGITTE
Other - Middle Name:
Other - Last Name:MASENGU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 806070
Mailing Address - Street 2:
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080
Mailing Address - Country:US
Mailing Address - Phone:586-777-2550
Mailing Address - Fax:586-777-2447
Practice Address - Street 1:22050 GREATER MACK
Practice Address - Street 2:
Practice Address - City:ST. CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48236
Practice Address - Country:US
Practice Address - Phone:586-777-2550
Practice Address - Fax:586-777-2447
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301407585207V00000X
MIBN407585207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2652582Medicaid
4301407585OtherCONTROLLED SUBSTANCE
C3423OtherM CARE PIN
MI4847009Medicaid
C0HRJOtherCLEARING HOUSE SUBMITTER
1608252141OtherBLUE CROSS BLUE SHIELD
117658OtherGREAT LAKES
117658OtherGREAT LAKES
1608252141OtherBLUE CROSS BLUE SHIELD
0P29050Medicare ID - Type Unspecified
BN1622390OtherDEA
1608252141OtherBLUE CROSS BLUE SHIELD
0P28680Medicare ID - Type Unspecified