Provider Demographics
NPI:1184666331
Name:GOULD, MONTIE R (MD)
Entity Type:Individual
Prefix:DR
First Name:MONTIE
Middle Name:R
Last Name:GOULD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 E COLUMBIA AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-4449
Mailing Address - Country:US
Mailing Address - Phone:269-969-6003
Mailing Address - Fax:269-969-6051
Practice Address - Street 1:842 E COLUMBIA AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4449
Practice Address - Country:US
Practice Address - Phone:269-969-6003
Practice Address - Fax:269-969-6051
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301038262207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4227943Medicaid
MI1C CJ8339OtherMEDICARE RR
MIA73275Medicare UPIN
MI0M99170001Medicare ID - Type Unspecified
MI0M98600004Medicare PIN
MI0M99170Medicare PIN