Organization Name: | JOHN T. GOLDEN, M.D. |
NPI Number: | 1942404348 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOHN THEODORE GOLDEN (OWNER) |
Mailing Address: | 25990 Kelly Rd Suite 4 Roseville |
State: | MI US |
Postal Code: | 480664483 |
Phone Number: | 5867760808 |
Fax Number: | 5867710953 |
NPI Enumeration Date: | 06/12/2007 |
NPI Last Update Date: | 05/05/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | JG052077 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |