Provider Demographics
NPI:1124196662
Name:FESDJIAN-GOGALTAN, OANA CRISTINA (MD)
Entity Type:Individual
Prefix:
First Name:OANA CRISTINA
Middle Name:
Last Name:FESDJIAN-GOGALTAN
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:HENRY FORD HEALTH SYSTEM
Mailing Address - Street 2:14500 HALL ROAD
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313
Mailing Address - Country:US
Mailing Address - Phone:586-247-2700
Mailing Address - Fax:
Practice Address - Street 1:HENRY FORD HEALTH SYSTEM
Practice Address - Street 2:14500 HALL ROAD
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313
Practice Address - Country:US
Practice Address - Phone:586-247-2700
Practice Address - Fax:586-247-2691
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074517207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
700H262220OtherBLUE CROSS-BLUE CROSS
OF074517OtherCHAMPUS-CHAMPUS
MI425225810Medicaid
OF074517OtherCOMMERCIAL-COMMERCIAL NUMBER