Provider Demographics
NPI:1083663983
Name:GOYERT, GREGORY L (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:L
Last Name:GOYERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3301 W GRAND ST
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-2793
Mailing Address - Country:US
Mailing Address - Phone:248-661-7384
Mailing Address - Fax:313-916-2984
Practice Address - Street 1:3301 W GRAND ST
Practice Address - Street 2:8TH FLOOR
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-2793
Practice Address - Country:US
Practice Address - Phone:248-661-7384
Practice Address - Fax:313-916-2984
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301046411207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF10093OtherHAP & HAP SENIOR PLUS
MI0822530OtherBCBS PPO
MI109726OtherPREFERRED CHOICES PPO
MI1607583OtherFIRST HEALTH
MI382524226OtherTRICARE EXTRA, STANDARD,
MI382524226OtherBCE EMERGIS
MI4320478OtherAETNA
MI7139017OtherCIGNA
MI382524226OtherTHE CHANDLER GROUP PRIMA
MI160055739OtherRAILROAD MEDICARE
MI4106545-10Medicaid
MIP49682OtherBCN
MI204801OtherONE HEALTH PLAN GREAT WES
MI5404716OtherCCN
MI0822530OtherBLUE PREFERRED PLUS
MI382524226OtherPPOM
MI382524226OtherUNITED HEALTHCARE
MIP49682OtherBCN
MI382524226OtherBCE EMERGIS
MIM84380002Medicare PIN