Healthcare Provider Details

I. General information

NPI: 1871434282
Provider Name (Legal Business Name): GEORGE MICHAEL GOOGASIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 DIXIE HWY STE 200
CLARKSTON MI
48346-5113
US

IV. Provider business mailing address

6770 DIXIE HWY STE 200
CLARKSTON MI
48346-5113
US

V. Phone/Fax

Practice location:
  • Phone: 248-276-8000
  • Fax:
Mailing address:
  • Phone: 248-276-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: