Healthcare Provider Details

I. General information

NPI: 1003068016
Provider Name (Legal Business Name): NITIN K.G.GOLECHHA MD,PC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2734 MAIN ST
MARLETTE MI
48453-1141
US

IV. Provider business mailing address

2734 MAIN ST
MARLETTE MI
48453-1141
US

V. Phone/Fax

Practice location:
  • Phone: 989-635-1871
  • Fax: 989-635-1872
Mailing address:
  • Phone: 989-635-1871
  • Fax: 989-635-1872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301071011
License Number StateMI

VIII. Authorized Official

Name: DR. NITIN K.G. GOLECHHA
Title or Position: PRESIDENT
Credential: MD
Phone: 989-635-1871