Organization
CHARLES B. GOSS, D.O., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES B. GOSS D.O. (PRESIDENT)
(248) 471-5700
Entity
Organization
Contact information
Practice address
28100 GRAND RIVER AVE, SUITE 102, FARMINGTON HILLS, MI 48336-5967
(248) 471-5700
(248) 851-5515
Mailing address
28100 GRAND RIVER AVE, SUITE 102, FARMINGTON HILLS, MI 48336-5967
(248) 471-5700
(248) 851-5515
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1091313 11 00
—
MI
01
—
260F338480
BLUE CROSS & BLUE SHIELD
MI
Enumeration date
01/02/2007
Last updated
01/25/2008
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