Individual
DR. PETER M GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
16001 W 9 MILE RD, SOUTHFIELD, MI 48075-4818
(248) 849-3000
Mailing address
PO BOX 100, ROYAL OAK, MI 48068-0100
(248) 849-3137
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
4301029764
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103394992
—
MI
05
—
104274934
—
MI
01
—
PG029764
BC/BS OF MICHIGAN
MI
Enumeration date
06/09/2006
Last updated
06/18/2010
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