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General NPI Number Information
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NPI Number | 1942340187
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Entity Type | Organization
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Legal Business Name | WALNUT LAKE OBGYN PLLC
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 06/18/2010
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Provider Practice Location Address
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Address Line | 2300 HAGGERTY RD STE 2070
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48323-2184
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Country | US
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Telephone | 248-926-2020
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Fax | 248-926-9020
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Provider Business Mailing Address
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Address Line | 2300 HAGGERTY RD STE 2070
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48323-2190
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Country | US
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Telephone | 248-926-2020
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Fax | 248-926-9020
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Authorized Official
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Title or Position | PARTNER
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Name | DR. ALAN D GOLDSMITH
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Credential | MD
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Telephone | 248-926-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | AG035173
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License Number State | MI
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