Provider Demographics
NPI:1093778037
Name:GOLD, PAUL M (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:GOLD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3560 PONTIAC LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-2337
Mailing Address - Country:US
Mailing Address - Phone:248-674-2259
Mailing Address - Fax:248-674-3356
Practice Address - Street 1:3560 PONTIAC LAKE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-2337
Practice Address - Country:US
Practice Address - Phone:248-674-2259
Practice Address - Fax:248-674-3356
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2010-05-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIPG005648207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1121172Medicaid
MIOF37176007Medicare ID - Type Unspecified
MIE26480Medicare UPIN