MEDICARE: POONAM GOEL MD

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	208000000X	Pediatrics Physician	4301081085	MI

General Provider Information

NPI Number	:	1134292469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	POONAM GOEL MD

Provider Business Mailing Address
First Line	:	3072 WOODCREEK WAY
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-1862
Country	:	US
Telephone Number	:	248-332-6999
Fax Number	:

Provider Business Practice Location Address
First Line	:	3072 WOODCREEK WAY
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-1862
Country	:	US
Telephone Number	:	248-332-6999
Fax Number	:

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	11/14/2012

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