Provider Demographics
NPI:1245233352
Name:MCGOUGH, MARTIN F (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:F
Last Name:MCGOUGH
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1701 SOUTH BLVD E
Mailing Address - Street 2:STE 390
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6117
Mailing Address - Country:US
Mailing Address - Phone:248-293-0055
Mailing Address - Fax:248-293-3348
Practice Address - Street 1:1701 SOUTH BLVD E
Practice Address - Street 2:STE 390
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6117
Practice Address - Country:US
Practice Address - Phone:248-293-0055
Practice Address - Fax:248-293-3348
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIMM073313207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI060050053OtherRAILROAD MEDICARE
MI3507497Medicaid
MI0F37182Medicare PIN
MI3507497Medicaid