Healthcare Provider Details

I. General information

NPI: 1144559642
Provider Name (Legal Business Name): STEPHEN I. GOLDMAN, D.O., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 12/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23995 NOVI RD SUITE C103
NOVI MI
48375-5439
US

IV. Provider business mailing address

23995 NOVI RD SUITE C103
NOVI MI
48375-5439
US

V. Phone/Fax

Practice location:
  • Phone: 248-380-1900
  • Fax: 248-380-0605
Mailing address:
  • Phone: 248-380-1900
  • Fax: 248-380-0605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN IRA GOLDMAN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 248-380-1900