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General NPI Number Information
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NPI Number | 1306903109
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Entity Type | Organization
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Legal Business Name | CHARLES B. GOSS, D.O., P.C.
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 01/25/2008
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Provider Practice Location Address
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Address Line | 28100 GRAND RIVER AVE SUITE 102
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-5967
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Country | US
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Telephone | 248-471-5700
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Fax | 248-851-5515
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Provider Business Mailing Address
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Address Line | 28100 GRAND RIVER AVE SUITE 102
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-5967
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Country | US
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Telephone | 248-471-5700
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Fax | 248-851-5515
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES B. GOSS
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Credential | D.O.
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Telephone | 248-471-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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