Provider Demographics
NPI:1770231458
Name:MIHINGO, MOSES MBOGO
Entity Type:Individual
Prefix:MR
First Name:MOSES
Middle Name:MBOGO
Last Name:MIHINGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 W HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:IN
Mailing Address - Zip Code:46567-1803
Mailing Address - Country:US
Mailing Address - Phone:260-348-0865
Mailing Address - Fax:
Practice Address - Street 1:309 W HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:IN
Practice Address - Zip Code:46567-1803
Practice Address - Country:US
Practice Address - Phone:260-348-0865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN88-0967440Medicaid