1669446050 NPI number — VINOD GOYAL MD

Table of content: VINOD GOYAL MD (NPI 1669446050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669446050 NPI number — VINOD GOYAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOYAL
Provider First Name:
VINOD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1669446050
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6576 CHELSEA BRG
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST BLOOMFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48322-3072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-478-5234
Provider Business Mailing Address Fax Number:
248-478-5307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2141 E JEFFERSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48207-4128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-259-9075
Provider Business Practice Location Address Fax Number:
313-259-3722
Provider Enumeration Date:
02/14/2006

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: 207RN0300X , with the licence number:  4301064216 , 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: 4708041 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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