DR. DIMITRIOS T. MOUGOLIAS


Address: 2799 W Grand Blvd, Detroit, MI 48202-2608
Phone: 3139162060

DR. DIMITRIOS T. MOUGOLIAS (NPI# 1053520700) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1053520700
Entity Type Individual
Full Name DR. DIMITRIOS T. MOUGOLIAS
Credential M.D.
Practice Address 2799 W Grand Blvd
Detroit
MI 48202-2608
Mailing Address 111 Spring St
Streator
IL 61364-3332
Practice Telephone 3139162060
Mailing Telephone 7088708289
Enumeration Date 2007-05-21
Last Update Date 2019-11-19
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207PE0004X Emergency Medicine
Specialization: Emergency Medical Services
036118251 IL Allopathic & Osteopathic Physicians

Provider Secondary Practice Location

Address Telephone Number Fax Number
1 Kish Hospital Dr, Dekalb, IL 601159602 8157482972

Office Location

Street Address 2799 W GRAND BLVD
City DETROIT
State MI
Zip Code 48202-2608

Providers in the same location

NPI Name Taxonomy Address Enumeration
1235132069 Donna Prince Radiology 2799 W Grand Blvd, Detroit, MI 48202-2608 2005-05-24
1790386704 Alexandria L Blevins Nurse Practitioner 2799 W Grand Blvd, Detroit, MI 48202-2608 2020-11-05
1255932430 Amy Katlyn Carion 2799 W Grand Blvd, Detroit, MI 48202-2608 2020-11-04
1871194415 Alexandria Denise Roberts Physical Therapist 2799 W Grand Blvd, Detroit, MI 48202-2689 2020-11-02
1174121420 John Charles Sanno Nurse Practitioner 2799 W Grand Blvd, Detroit, MI 48202-2689 2020-10-09
1932706991 Fallon J Awe Nurse Practitioner 2799 W Grand Blvd, Detroit, MI 48202-2608 2020-10-02
1922615145 Chelsea Elizabeth Owen Nurse Anesthetist, Certified Registered 2799 W Grand Blvd, Detroit, MI 48202-2608 2020-10-01
1275130395 Zana Latkovac Nurse Practitioner 2799 W Grand Blvd, Detroit, MI 48202-2608 2020-10-01
1487260030 Jessica Lee Moret Nurse Practitioner 2799 W Grand Blvd, Detroit, MI 48202-2608 2020-09-18
1932713237 Lucas Costa Santos Anesthesiology 2799 W Grand Blvd, Detroit, MI 48202-2608 2020-09-03
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1710584602 Andrea Irene Martin Audiologist 2799 E Grand Blvd, Detroit, MI 48202 2020-10-05
1174132583 Odei Alayyas Student in an Organized Health Care Education/Training Program 2799 W. Grand Boulevard Henry Ford Hospital, Medical Ed, Detroit, MI 48202 2020-07-31
1912529801 Aroob Nabil Nimer Sweidan Student in an Organized Health Care Education/Training Program 2799 West Grand Boulvard, Department of Internal Meidicine, Cfp 1, Detroit, MI 48202 2020-05-13
1306485636 Katie Burlen-davis Registered Nurse 9045 Woodward Ave, Detroit, MI 48202 2020-01-03
1407401250 Santhalakshmi Angappan Student in an Organized Health Care Education/Training Program Henry Ford Hospital Medical Education Department, 2799 W. Grand Boulevard, Detroit, MI 48202 2019-08-08
1851945687 Walter Mitini Etoh Nurse Practitioner Henry Ford Hospital I1 Observation, 2799 W. Grand Blvd, Detroit, MI 48202 2019-07-30
1467913756 Andrew Michael Schock Emergency Medicine Ceci Murrell-harvey, Henry Ford Hospital, 2799 W. Grand. Blvd, Cfp 046, Detroit, MI 48202 2019-03-28
1700363892 Zaid Al-saheli Student in an Organized Health Care Education/Training Program 2799 W. Grand Blvdl, Cfp 046, Hope Peck, Detroit, MI 48202 2018-07-23
1932690096 Yusuf Naser Alalwan Student in an Organized Health Care Education/Training Program 2799 W. Grand Blvd. Henry Ford Hospital - Gme Office, Detroit, MI 48202 2018-05-24
1568952729 Kelvin Sellers Massage Therapist 832 Seward, Detriot, MI 48202 2018-05-14
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Taxonomy Information

Taxonomy Code 207PE0004X
Grouping Allopathic & Osteopathic Physicians
Classification Emergency Medicine
Specialization Emergency Medical Services

Taxonomy Definition

An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients.
Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1013275866 Brooke M Frakes Emergency Medicine 6071 W Outer Dr, Detroit, MI 48235-2624 2012-04-30
1568728137 David Wesley Strong Emergency Medicine 4201 Saint Antoine St, Suite 3r, Detroit, MI 48201-2153 2012-04-07
1093090458 Candace Nicole Johnson Emergency Medicine 6071 W Outer Dr, Detroit, MI 48235-2624 2011-10-18
1881826311 Emmanuel Ayodele Oke Jr. Emergency Medicine 22101 Moross Rd, Detroit, MI 48236-2148 2009-08-17
1407084296 Monty Rex Lybbert Emergency Medicine 6071 W Outer Dr, Detroit, MI 48235-2624 2009-06-30
1043466592 Megan Duffey Bonanni Emergency Medicine 6071 W Outer Dr, Detroit, MI 48235-2624 2008-08-15
1801062930 Christopher James Budziak Emergency Medicine 4201 Saint Antoine St, Suite 6g, Detroit, MI 48201-2153 2008-05-08
1871766998 Anoop Qadir Majjhoo Emergency Medicine 4201 St Antoine, 3r Detroit Receiving Hospital, Detroit, MI 48201 2008-04-09
1033326822 Luke Christopher Craig Saski Emergency Medicine 3990 John R St, Detroit, MI 48201-2018 2007-05-17
1578692091 Ryan P Robinson Emergency Medicine 4201 Saint Antoine St, Suite 3r, Detroit, MI 48201 2007-03-02
Find all providers in DETROIT

Competitor

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City DETROIT
Zip Code 48202

Improve Information

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Dataset Information

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.

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