Provider Demographics
NPI:1275746547
Name:GOGAN, NEAL WARREN (MD)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:WARREN
Last Name:GOGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:198 EDGEHILL DR
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-3922
Mailing Address - Country:US
Mailing Address - Phone:269-660-9606
Mailing Address - Fax:269-833-3431
Practice Address - Street 1:7000 PORTAGE RD
Practice Address - Street 2:PORT 41-004
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-0102
Practice Address - Country:US
Practice Address - Phone:269-833-8691
Practice Address - Fax:269-833-3431
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010437182083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2622663Medicaid
MI2622663Medicaid