Provider Demographics
NPI:1770214991
Name:MUDGAL, GAURAV (MD)
Entity Type:Individual
Prefix:MR
First Name:GAURAV
Middle Name:
Last Name:MUDGAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ST. JOSEPH MERCY OAKLAND HOSPITAL
Mailing Address - Street 2:44405 WOODWARD AVENUE, MEDICAL EDUCATION DEPARTMENT H23
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341
Mailing Address - Country:US
Mailing Address - Phone:718-912-4771
Mailing Address - Fax:
Practice Address - Street 1:ST. JOSEPH MERCY OAKLAND HOSPITAL
Practice Address - Street 2:44405 WOODWARD AVENUE, MEDICAL EDUCATION DEPARTMENT H23
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341
Practice Address - Country:US
Practice Address - Phone:248-858-6233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2023-03-20
Deactivation Date:2023-03-08
Deactivation Code:
Reactivation Date:2023-03-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program