Individual
DR. CHARLES G GODOSHIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
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
—
1106346941
BLUE CROSS BLUE SHIELD
MI
05
—
1731411
—
MI
Enumeration date
09/12/2005
Last updated
11/01/2011
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