MEDICARE: TODD C GOULD DO OC

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	207RS0012X	Sleep Medicine (Internal Medicine) Physician	5101006091	MI

General Provider Information

NPI Number	:	1124220140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TODD C GOULD DO OC

Provider Business Mailing Address
First Line	:	305 BARCLAY CIR
Second Line	:	SUITE 1000
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-4572
Country	:	US
Telephone Number	:	248-853-0800
Fax Number	:	248-853-2809

Provider Business Practice Location Address
First Line	:	305 BARCLAY CIR
Second Line	:	SUITE 1000
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-4572
Country	:	US
Telephone Number	:	248-853-0800
Fax Number	:	248-853-2809

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. JOANNE S GODORICH
Credential	:	CMA
Telephone Number	:	248-853-0800

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	08/22/2020

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