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General NPI Number Information
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NPI Number | 1073313870
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Entity Type | Individual
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Provider Name | GWEN GOODROW MD
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Gender | Female
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 2250 GENOA BUSINESS PARK DRIVE SUITE 110
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City | BRIGHTON
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State | MI
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Zip | 48114
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Country | US
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Telephone | 810-227-3232
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Fax | 810-227-3237
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Provider Business Mailing Address
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Address Line | 2250 GENOA BUSINESS PK DRIVE SUITE 110
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City | BRIGHTON
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State | MI
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Zip | 48114
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Country | US
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Telephone | 810-227-3232
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Fax | 810-227-3237
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | 4301513032
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License Number State | MI
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