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Individual

MR. ROCELIOUS GOODSON III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
4241 MAPLE ST, SUITE 200 D, DEARBORN, MI 48126-3826
(313) 584-1940
(313) 584-1945
Mailing address
5790 NEWBERRY ESTATES DR, WESTLAND, MI 48185-8300
(313) 850-6552

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601004396
MI

Other

Enumeration date
12/04/2006
Last updated
05/27/2008
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