Healthcare Provider Details

I. General information

NPI: 1487397931
Provider Name (Legal Business Name): MICHAEL GOLDENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 CARTER AVE
ASHLAND KY
41101-1943
US

IV. Provider business mailing address

814 CARPENTER RD
LOVELAND OH
45140-8101
US

V. Phone/Fax

Practice location:
  • Phone: 606-324-1483
  • Fax: 606-329-2612
Mailing address:
  • Phone: 513-227-7415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD.46945
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number57.252592
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number62179
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: