Provider Demographics
NPI:1225072275
Name:GOLDMAN, LYLE STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:LYLE
Middle Name:STEVEN
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22301 FOSTER WINTER DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3707
Mailing Address - Country:US
Mailing Address - Phone:248-552-0620
Mailing Address - Fax:248-552-0286
Practice Address - Street 1:22301 FOSTER WINTER DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3707
Practice Address - Country:US
Practice Address - Phone:248-552-0620
Practice Address - Fax:248-552-0286
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILG053853207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104131000Medicaid
MI0M75300010Medicare ID - Type Unspecified
MID82919Medicare UPIN