Healthcare Provider Details

I. General information

NPI: 1013582808
Provider Name (Legal Business Name): STEVEN B GOLDENTHAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19000 ST JOE'S PARKWAY SUITE 320
LIVONIA MI
48152
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DRIVE SUITE J2000
ANN ARBOR MI
48105
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-8100
  • Fax: 734-887-8942
Mailing address:
  • Phone: 734-747-6766
  • Fax: 734-222-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301517794
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: