Healthcare Provider Details

I. General information

NPI: 1427158963
Provider Name (Legal Business Name): THEODORE ALFRED PAUL GOLDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 SHAGBARK DR
ROCHESTER HILLS MI
48309-1816
US

IV. Provider business mailing address

181 SHAGBARK DR
ROCHESTER HILLS MI
48309-1816
US

V. Phone/Fax

Practice location:
  • Phone: 248-626-2252
  • Fax:
Mailing address:
  • Phone: 248-626-2252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4301028806
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: