Healthcare Provider Details

I. General information

NPI: 1568797348
Provider Name (Legal Business Name): MARILYN BARBARA GOLDMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BARBARA GOLDMAN-MINKIN M.D.

II. Dates (important events)

Enumeration Date: 10/12/2009
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 N OAKLAND BLVD 1ST FLOOR, SUITE 120
WATERFORD MI
48327-4525
US

IV. Provider business mailing address

6800E 10 MILE RD
CENTER LINE MI
48015-1167
US

V. Phone/Fax

Practice location:
  • Phone: 248-618-3920
  • Fax: 248-618-3953
Mailing address:
  • Phone: 586-756-7777
  • Fax: 810-458-4187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301089099
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: