Provider Demographics
NPI:1821066697
Name:GOGUE, HIKMAT P (MD)
Entity Type:Individual
Prefix:
First Name:HIKMAT
Middle Name:P
Last Name:GOGUE
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 1:3352 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:MI
Mailing Address - Zip Code:48382-1957
Mailing Address - Country:US
Mailing Address - Phone:586-446-8060
Mailing Address - Fax:
Practice Address - Street 1:39242 DEQUINDRE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-1764
Practice Address - Country:US
Practice Address - Phone:586-446-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010443922080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4418981Medicaid
MI4423936Medicaid
MI4418981Medicaid