Individual
CARLOS A GODOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4700 SCHAEFER RD, DEARBORN, MI 48126-3698
(313) 581-2600
(313) 581-0228
Mailing address
33651 OAK POINT CIR, FARMINGTON HILLS, MI 48331-2768
(248) 553-0717
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
CG033015
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001015
MIDWEST HEALTH PLAN
MI
01
—
112307
GREAT LAKES HEALTH PLAN
MI
05
—
1358084
—
MI
01
—
236661
MEDICARE PROVIDER NO
MI
01
—
340H210660
BCBSM/BCN
MI
01
—
4471546
AETNA
MI
01
—
50801
OMNI A COVENTRY HEALTH PL
MI
Enumeration date
03/24/2006
Last updated
02/28/2012
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