Doctor Name: | STEPHEN IRA GOLDMAN |
NPI Number: | 1619036118 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | SG008887 |
Business Practice Address: | 23995 Novi Rd Suite C103 Novi, MI - 483755439 |
Business Phone Number: | 2483801900 |
Business Fax Number: | 2483800605 |
Mailing Address: | 23995 Novi Rd, Suite C103 NOVI |
State: | MI |
Postal Code: | 483755439 |
Phone Number: | 2483801900 |
Fax Number: | 2483800605 |
NPI Enumeration Date: | 12/08/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 204D00000X |
License Number: | SG008887 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
Taxonomy Specialization: | |
Taxonomy Definition: |