Healthcare Provider Details

I. General information

NPI: 1598740987
Provider Name (Legal Business Name): GOLDMAN AND MILLER CARDIOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30335 W 13 MILE RD SUITE 103
FARMINGTON HILLS MI
48334-2262
US

IV. Provider business mailing address

30335 W 13 MILE RD SUITE 103
FARMINGTON HILLS MI
48334-2262
US

V. Phone/Fax

Practice location:
  • Phone: 248-419-3400
  • Fax: 248-419-3410
Mailing address:
  • Phone: 248-419-3400
  • Fax: 248-419-3410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LARY S GOLDMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 248-419-3400