Organization
CHARLES G. GODOSHIAN, M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES G GODOSHIAN M.D. (PRESIDENT)
(248) 353-0882
Entity
Organization
Contact information
Practice address
27177 LAHSER RD, SUITE 104, SOUTHFIELD, MI 48034-4714
(248) 353-0882
(248) 353-0883
Mailing address
27177 LAHSER RD, SUITE 104, SOUTHFIELD, MI 48034-4714
(248) 353-0882
(248) 353-0883
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
CG046652
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F38121
BLUE CROSS BLUE SHIELD OF MICHIGAN
MI
05
—
1731411
—
MI
Enumeration date
06/22/2007
Last updated
06/02/2009
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