Healthcare Provider Details

I. General information

NPI: 1083663983
Provider Name (Legal Business Name): GREGORY L GOYERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 W GRAND ST 8TH FLOOR
DETROIT MI
48238-2793
US

IV. Provider business mailing address

3301 W GRAND ST 8TH FLOOR
DETROIT MI
48238-2793
US

V. Phone/Fax

Practice location:
  • Phone: 248-661-7384
  • Fax: 313-916-2984
Mailing address:
  • Phone: 248-661-7384
  • Fax: 313-916-2984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number4301046411
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: