Provider Demographics
NPI:1164405437
Name:GOLDMEIER, PHILLIP A (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:A
Last Name:GOLDMEIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30055 NORTHWESTERN HWY
Mailing Address - Street 2:STE 250
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334
Mailing Address - Country:US
Mailing Address - Phone:248-985-5000
Mailing Address - Fax:248-985-5500
Practice Address - Street 1:30055 NORTHWESTERN HWY
Practice Address - Street 2:STE 250
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334
Practice Address - Country:US
Practice Address - Phone:248-985-5000
Practice Address - Fax:248-985-5500
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301054096207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3512693Medicaid
MI3512693Medicaid
0M69450002Medicare ID - Type Unspecified