Provider Demographics
NPI:1174507404
Name:GOLECHHA, NITIN KG (MD)
Entity Type:Individual
Prefix:DR
First Name:NITIN
Middle Name:KG
Last Name:GOLECHHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2734 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARLETTE
Mailing Address - State:MI
Mailing Address - Zip Code:48453-1141
Mailing Address - Country:US
Mailing Address - Phone:989-635-1871
Mailing Address - Fax:989-635-1872
Practice Address - Street 1:2734 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLETTE
Practice Address - State:MI
Practice Address - Zip Code:48453-1141
Practice Address - Country:US
Practice Address - Phone:989-635-1871
Practice Address - Fax:989-635-1872
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071011207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1199001OtherMEDICARE PTAN
MI1107601131OtherBLUE CROSS PIN
1174507404OtherNPI