Provider Demographics
NPI:1043258759
Name:GOLDMAKHER, TERA MELANNE (MD)
Entity Type:Individual
Prefix:
First Name:TERA
Middle Name:MELANNE
Last Name:GOLDMAKHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38935 ANN ARBOR RD
Mailing Address - Street 2:CREDENTIALING
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3397
Mailing Address - Country:US
Mailing Address - Phone:734-805-0488
Mailing Address - Fax:866-250-6385
Practice Address - Street 1:33155 ANNAPOLIS ST
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2405
Practice Address - Country:US
Practice Address - Phone:734-467-4042
Practice Address - Fax:734-467-5500
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35769207Q00000X
CAC53679207P00000X
MI4301078436207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11352458OtherCAQH
AZ116476Medicaid
CA1043258759Medicaid