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General NPI Number Information
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NPI Number | 1124211131
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Entity Type | Organization
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Legal Business Name | PAUL GOLDSHLACK DO PC
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 08/22/2007
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Provider Practice Location Address
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Address Line | 1200 E MICHIGAN AVE SUITE 500
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City | LANSING
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State | MI
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Zip | 48912-1800
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Country | US
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Telephone | 517-484-4095
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 492
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City | OKEMOS
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State | MI
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Zip | 48805-0492
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Country | US
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Telephone | 517-484-4095
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL ALAN GOLDSHLACK
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Credential | DO
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Telephone | 517-484-4095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | PG007284
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License Number State | MI
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