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General NPI Number Information
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NPI Number | 1508158759
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Entity Type | Individual
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Provider Name | MICHAEL JAY GOLDSTEIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/06/2011
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Last Update Date | 02/25/2016
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Provider Practice Location Address
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Address Line | 1251 JOSLYN AVE 483-109-750
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City | PONTIAC
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State | MI
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Zip | 48340-2064
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Country | US
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Telephone | 248-857-3524
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Fax |
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Provider Business Mailing Address
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Address Line | 2667 BIRCH HARBOR LN 483-109-750
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48324-1905
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Country | US
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Telephone | 248-568-3260
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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 | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 4301055488
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License Number State | MI
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