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General NPI Number Information
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NPI Number | 1699769190
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Entity Type | Individual
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Provider Name | CHARLES G GODOSHIAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/12/2005
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 27177 LAHSER RD SUITE 104
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City | SOUTHFIELD
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State | MI
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Zip | 48034-4714
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Country | US
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Telephone | 248-353-0882
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Fax | 248-353-0883
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Provider Business Mailing Address
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Address Line | 27177 LAHSER RD SUITE 104
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City | SOUTHFIELD
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State | MI
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Zip | 48034-4714
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Country | US
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Telephone | 248-353-0882
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Fax | 248-353-0883
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | CG046652
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License Number State | MI
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