Provider Demographics
NPI:1356151351
Name:MEDINFUSE PLLC
Entity type:Organization
Organization Name:MEDINFUSE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOGUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-561-4812
Mailing Address - Street 1:4612 RIVERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-4160
Mailing Address - Country:US
Mailing Address - Phone:248-561-4812
Mailing Address - Fax:
Practice Address - Street 1:20000 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2428
Practice Address - Country:US
Practice Address - Phone:248-561-4812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty