Individual
TERA MELANNE GOLDMAKHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
33155 ANNAPOLIS ST, EMERGENCY DEPT, WAYNE, MI 48184-2405
(734) 467-4042
(734) 467-5500
Mailing address
38935 ANN ARBOR RD, CREDENTIALING, LIVONIA, MI 48150-3397
(734) 805-0488
(866) 250-6385
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
4301078436
MI
207P00000X
Emergency Medicine Physician
C53679
CA
207Q00000X
Family Medicine Physician
35769
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043258759
—
CA
01
—
11352458
CAQH
MI
05
—
116476
—
AZ
Enumeration date
06/03/2006
Last updated
06/26/2013
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