Healthcare Provider Details

I. General information

NPI: 1326330945
Provider Name (Legal Business Name): GEORGE EDWARD GOPOIAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28080 GRAND RIVER AVE
FARMINGTON HILLS MI
48336-5966
US

IV. Provider business mailing address

28080 GRAND RIVER AVE
FARMINGTON HILLS MI
48336-5966
US

V. Phone/Fax

Practice location:
  • Phone: 248-471-8000
  • Fax:
Mailing address:
  • Phone: 248-471-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002376
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: