Individual
DR. GARY R GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
22250 PROVIDENCE DR STE 606, SOUTHFIELD, MI 48075-6214
(248) 443-1281
(248) 443-1411
Mailing address
1030 HARRINGTON ST STE 203, MOUNT CLEMENS, MI 48043-2967
(586) 493-9229
(586) 493-4396
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
4301044225
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10 3282495
—
MI
Enumeration date
04/20/2006
Last updated
08/26/2019
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