Provider Demographics
NPI:1124004882
Name:MOGAN, WILLIAM (MAC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:MOGAN
Suffix:
Gender:M
Credentials:MAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3249 HENNEPIN AVE S
Mailing Address - Street 2:#227
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3411
Mailing Address - Country:US
Mailing Address - Phone:612-578-8980
Mailing Address - Fax:
Practice Address - Street 1:3249 HENNEPIN AVE S
Practice Address - Street 2:#227
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-3411
Practice Address - Country:US
Practice Address - Phone:612-578-8980
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1051171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist