Kirsten I Mogbo, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

4301059222 Issued in MI

Practice address

2799 W. Grand Blvd.
Detroit, MI 48202

Phone

(214) 645-9729

Fax

(214) 645-9289

NPI assigned

Apr 12, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Medical Imaging of Dallas, LLP

  • Specialist
  • Irving, TX
  • NPI 1972694099
  NPD (past)

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

{
    "created_epoch": "1144800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395705600000",
    "number": "1568426294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2799 W. GRAND BLVD.",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48202",
            "telephone_number": "313-916-7425",
            "fax_number": "313-916-7925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2799 W. GRAND BLVD.",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48202",
            "telephone_number": "214-645-9729",
            "fax_number": "214-645-9289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOGBO",
        "first_name": "KIRSTEN",
        "middle_name": "I",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-12",
        "last_updated": "2014-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "4301059222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "118182804",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashish M Mody, M.D.
• Anzor Modzgvreschvili, RD
• Kelsie Marie Moeller, DO
• Kristen Moerchen
• Savannah Rose Moffat
• Marjan Moghaddam, D.O
• Lylas G. Mogk, M.D.
• Bashar Nasour Mohamad, MD
• Tamam Mohamad
• Mohamed Moctar Mohamed Moctar

• Diagnostic Radiology Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• Diagnostic Radiology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.