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General NPI Number Information
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NPI Number | 1316095987
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Entity Type | Individual
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Provider Name | BETH GOLDMAN M.D., M.P.H.
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Gender | Female
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 55 W MAPLE RD SUITE 206
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City | BIRMINGHAM
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State | MI
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Zip | 48009-3303
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Country | US
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Telephone | 248-642-2320
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Fax |
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Provider Business Mailing Address
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Address Line | 55 W MAPLE RD SUITE 206
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City | BIRMINGHAM
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State | MI
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Zip | 48009-3303
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Country | US
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Telephone | 248-642-2320
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301051554
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License Number State | MI
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