Provider Demographics
NPI:1225489784
Name:GOULET, MARC PETER (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:PETER
Last Name:GOULET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:37000 GRAND RIVER AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-2868
Mailing Address - Country:US
Mailing Address - Phone:248-536-2127
Mailing Address - Fax:248-893-6952
Practice Address - Street 1:37000 GRAND RIVER AVE STE 310
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335
Practice Address - Country:US
Practice Address - Phone:248-536-2127
Practice Address - Fax:248-893-6952
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2019-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301117055207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine