Provider Demographics
NPI:1265487466
Name:GOLDBERG, ALAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:P
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 320295
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-0005
Mailing Address - Country:US
Mailing Address - Phone:810-244-8816
Mailing Address - Fax:810-733-8613
Practice Address - Street 1:1284 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3407
Practice Address - Country:US
Practice Address - Phone:810-244-8816
Practice Address - Fax:810-733-8613
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIAG047658207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP04130001Medicare PIN