1083663983 NPI number — DR. GREGORY L GOYERT M.D.

Table of content: DR. GREGORY L GOYERT M.D. (NPI 1083663983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083663983 NPI number — DR. GREGORY L GOYERT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOYERT
Provider First Name:
GREGORY
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083663983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3301 W GRAND ST
Provider Second Line Business Mailing Address:
8TH FLOOR
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48238-2793
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-661-7384
Provider Business Mailing Address Fax Number:
313-916-2984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3301 W GRAND ST
Provider Second Line Business Practice Location Address:
8TH FLOOR
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48238-2793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-661-7384
Provider Business Practice Location Address Fax Number:
313-916-2984
Provider Enumeration Date:
05/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VM0101X , with the licence number:  4301046411 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F10093 . This is a "HAP & HAP SENIOR PLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0822530 . This is a "BCBS PPO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 109726 . This is a "PREFERRED CHOICES PPO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1607583 . This is a "FIRST HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 382524226 . This is a "TRICARE EXTRA, STANDARD," identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 382524226 . This is a "BCE EMERGIS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4320478 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7139017 . This is a "CIGNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 382524226 . This is a "THE CHANDLER GROUP PRIMA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 160055739 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4106545-10 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: P49682 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 204801 . This is a "ONE HEALTH PLAN GREAT WES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5404716 . This is a "CCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0822530 . This is a "BLUE PREFERRED PLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 382524226 . This is a "PPOM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 382524226 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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