Healthcare Provider Details

I. General information

NPI: 1720292923
Provider Name (Legal Business Name): GOODRICH MEDICAL CENTER P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 11/29/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5339 S STATE RD
GOODRICH MI
48438-8846
US

IV. Provider business mailing address

3495 S CENTER RD
BURTON MI
48519-1455
US

V. Phone/Fax

Practice location:
  • Phone: 810-636-2231
  • Fax: 810-636-7174
Mailing address:
  • Phone: 810-424-2007
  • Fax: 810-743-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301080418
License Number StateMI

VIII. Authorized Official

Name: YAMINI RAMALINGAM
Title or Position: OWNER
Credential: MD
Phone: 810-636-2231