MEDICARE: DR. GREGORY L GOYERT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VM0101X	Maternal & Fetal Medicine Physician	4301046411	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
10	160055739	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F10093	OTHER	MI	HAP & HAP SENIOR PLUS
2	0822530	OTHER	MI	BCBS PPO
3	109726	OTHER	MI	PREFERRED CHOICES PPO
4	1607583	OTHER	MI	FIRST HEALTH
5	382524226	OTHER	MI	TRICARE EXTRA, STANDARD,
6	382524226	OTHER	MI	BCE EMERGIS
7	4320478	OTHER	MI	AETNA
8	7139017	OTHER	MI	CIGNA
9	382524226	OTHER	MI	THE CHANDLER GROUP PRIMA
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	P49682	OTHER	MI	BCN
13	204801	OTHER	MI	ONE HEALTH PLAN GREAT WES
14	5404716	OTHER	MI	CCN
15	0822530	OTHER	MI	BLUE PREFERRED PLUS
16	382524226	OTHER	MI	PPOM
17	382524226	OTHER	MI	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1083663983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY L GOYERT M.D.

Provider Business Mailing Address
First Line	:	3301 W GRAND ST
Second Line	:	8TH FLOOR
City	:	DETROIT
State	:	MI
Zip	:	48238-2793
Country	:	US
Telephone Number	:	248-661-7384
Fax Number	:	313-916-2984

Provider Business Practice Location Address
First Line	:	3301 W GRAND ST
Second Line	:	8TH FLOOR
City	:	DETROIT
State	:	MI
Zip	:	48238-2793
Country	:	US
Telephone Number	:	248-661-7384
Fax Number	:	313-916-2984

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	10/12/2011

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