Provider Demographics
NPI:1124220140
Name:TODD C GOULD DO OC
Entity Type:Organization
Organization Name:TODD C GOULD DO OC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GODORICH
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:248-853-0800
Mailing Address - Street 1:305 BARCLAY CIR
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4572
Mailing Address - Country:US
Mailing Address - Phone:248-853-0800
Mailing Address - Fax:248-853-2809
Practice Address - Street 1:305 BARCLAY CIR
Practice Address - Street 2:SUITE 1000
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4572
Practice Address - Country:US
Practice Address - Phone:248-853-0800
Practice Address - Fax:248-853-2809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006091207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N95610Medicare ID - Type Unspecified
MIE40186Medicare UPIN