Healthcare Provider Details

I. General information

NPI: 1407061625
Provider Name (Legal Business Name): CORRINE MARY GODWIN CAUGHRAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8303 PLATT RD
SALINE MI
48176-9773
US

IV. Provider business mailing address

8303 PLATT RD
SALINE MI
48176-9773
US

V. Phone/Fax

Practice location:
  • Phone: 734-429-2531
  • Fax:
Mailing address:
  • Phone: 734-429-2531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number4301048026
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: