MONGKOL MONG, M.D.P.C. (NPI# 1316079452) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316079452 |
| Entity Type | Organization |
| Organization Name | MONGKOL MONG, M.D.P.C. |
| Practice Address |
15332 Fort St Southgate MI 48195-1304 |
| Practice Telephone | 7342852255 |
| Practice Fax Number | 7342859044 |
| Mailing Telephone | 7342852255 |
| Mailing Fax Number | 7342859044 |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. MONGKOL MONGKOLPRADIT (PRESIDENT) |
| Authorized Official Telephone | 7342852255 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | MM032063 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | MEDICAL LICENSE | MM032063 | 01 |
| MI | BLUE CROSS BLUE SHIELD | 0828033 | 01 |
| MI | 1421722 | 05 |
| Street Address |
15332 FORT ST |
| City | SOUTHGATE |
| State | MI |
| Zip Code | 48195-1304 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366435075 | Mongkol Mongkolpradit | Internal Medicine | 15332 Fort St, Southgate, MI 48195-1304 | 2005-08-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780206656 | Destiny D Harris | Social Worker | 14799, Southgate, MI 48195 | 2020-05-13 |
| 1285102368 | Svs Vision Inc | Eyewear Supplier (Equipment, not the service) | 16256 Fort St, Southgate, MI 48195 | 2018-11-07 |
| 1003382979 | Saran Charisse Watts | Case Manager/Care Coordinator | 31101 Allen Rd, Building 5, Southgate, MI 48195 | 2018-10-18 |
| 1255824025 | Kiesta Janell Lindsey | Social Worker | 13101 Allen Rd Bldg 4-f, Southgate, MI 48195 | 2018-06-07 |
| 1417473224 | Suzette Michele Watson | Nurse Practitioner | 14319 Dix-toledo, Southgate, MI 48195 | 2017-08-15 |
| 1275069486 | Liza Du Plessis | Student in an Organized Health Care Education/Training Program | 13111 Allen Road, Southgate, MI 48195 | 2017-05-08 |
| 1497290456 | Beaumont Health | Clinic/Center | 15777 Northline, Southgate, MI 48195 | 2016-12-30 |
| 1184172876 | Felicia Wilson | Licensed Practical Nurse | 15771 Wildemere, Southgate, MI 48195 | 2016-09-12 |
| 1225487978 | Stacey Petrick-strickland | Technician, Other | 12189 Agnes, Southgate, MI 48195 | 2016-06-03 |
| 1205298486 | Ashley Francis | Hearing Instrument Specialist | 18800 Eureka Rd., Southgate, MICHIGAN 48195 | 2016-03-25 |
| Find all providers in zip 48195 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649704495 | Zachary Norman Ginsburg | Internal Medicine | 15428 Devoe St, Southgate, MI 48195-2663 | 2017-04-19 |
| 1316203102 | Wyandotte Physician Practices | Internal Medicine | 15450 Northline Rd Ste 101, Southgate, MI 48195-2490 | 2012-04-05 |
| 1033263884 | Ramalingeswara R. Yalamanchi | Internal Medicine | 13300 Northline Rd, Southgate, MI 48195-1065 | 2007-01-22 |
| 1295891067 | Jagdish Kumar Sachdeva | Internal Medicine | 15105 Northline Rd, Southgate, MI 48195 | 2006-12-28 |
| 1326057589 | Syed M Danish | Internal Medicine | 13819 Trenton Rd, Southgate, MI 48195-1830 | 2006-08-05 |
| 1851318836 | Abdulqadir M Mussani | Internal Medicine | 12815 Northline Rd, Southgate, MI 48195-1109 | 2006-07-16 |
| 1174550974 | Yassir Attalla | Internal Medicine | 15450 Northline Rd Ste 102, Southgate, MI 48195-2490 | 2006-06-27 |
| 1902853252 | Mary E Petty-dudley | Internal Medicine | 3 Heritage Dr, Suite 1, Southgate, MI 48195-3000 | 2006-05-30 |
| 1740252089 | Ladan Amini-oroumi | Internal Medicine | 15450 Northline Rd, Ste 101, Southgate, MI 48195-2398 | 2006-02-02 |
| 1659356400 | Douglas John Zakolski | Internal Medicine | 14319 Dix Toledo Rd, Southgate, MI 48195-2506 | 2005-12-14 |
| Find all providers in SOUTHGATE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.