Mongkol Mong, M.D.P.C.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MM032063 Issued in MI

Legal business name

MONGKOL MONG, M.D.P.C.

Practice address

15332 Fort St
Southgate, MI 48195-1304

Phone

(734) 285-2255

Fax

(734) 285-9044

NPI assigned

Mar 12, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mongkol Mongkolpradit, M.D.

Title

President

Phone

(734) 285-2255

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nathan Bining, MD

  • Internal Medicine Physician
  • Livonia, MI
  • NPI 1538102165
  NPD (past)
• Dipak K Das, M.D.

  • Internal Medicine Physician
  • Wyandotte, MI
  • NPI 1699755181
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316079452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15332 FORT ST",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481951304",
            "telephone_number": "734-285-2255",
            "fax_number": "734-285-9044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15332 FORT ST",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481951304",
            "telephone_number": "734-285-2255",
            "fax_number": "734-285-9044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONGKOL MONG, M.D.P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MONGKOLPRADIT",
        "authorized_official_first_name": "MONGKOL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "734-285-2255",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "MM032063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1421722",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0828033",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "MM032063",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marina Modzelewski
• Megha Mohey, MD
• Jenny Moinhos, LLPC
• Monas Pharmacy LLC
• Kourtni Moncrease
• Mongkol Mongkolpradit, M.D.
• Jazminn Monson, FNP-C
• Chayela Montagano
• Johanna Montemayor, PT
• Vanessa Montemayor

• Internal Medicine Physician in Southgate, MI
• Providers in Southgate, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.