Healthcare Provider Details

I. General information

NPI: 1760426100
Provider Name (Legal Business Name): GOLDINNO HEALTHCARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7092 HIGHLAND RD STE 206
WATERFORD MI
48327
US

IV. Provider business mailing address

3360 COLLIDGE HWY
ROYAL OAK MI
48073
US

V. Phone/Fax

Practice location:
  • Phone: 248-889-9282
  • Fax: 248-889-7534
Mailing address:
  • Phone: 248-889-9282
  • Fax: 248-889-7534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberIA075373
License Number StateMI

VIII. Authorized Official

Name: DR. INNOCENT AGBASSI
Title or Position: MEDICAL DIRECTOR/CEO
Credential: MD
Phone: 248-889-9282