Provider Demographics
NPI:1003068016
Name:NITIN K.G.GOLECHHA MD,PC.
Entity Type:Organization
Organization Name:NITIN K.G.GOLECHHA MD,PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NITIN
Authorized Official - Middle Name:KG
Authorized Official - Last Name:GOLECHHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-635-1871
Mailing Address - Street 1:2734 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARLETTE
Mailing Address - State:MI
Mailing Address - Zip Code:48453-1141
Mailing Address - Country:US
Mailing Address - Phone:989-635-1871
Mailing Address - Fax:989-635-1872
Practice Address - Street 1:2734 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLETTE
Practice Address - State:MI
Practice Address - Zip Code:48453-1141
Practice Address - Country:US
Practice Address - Phone:989-635-1871
Practice Address - Fax:989-635-1872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071011207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1003068016OtherNPI
MI1199OtherMEDICARE PTAN