Provider Demographics
NPI:1285673558
Name:GOLDBERG, JOEL LEE (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:LEE
Last Name:GOLDBERG
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 1:300 NORTH AVENUE
Mailing Address - Street 2:BATTLE CREEK HEALTH SYSTEMS EMERGENCY DEPARTMENT
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3307
Mailing Address - Country:US
Mailing Address - Phone:800-726-3627
Mailing Address - Fax:
Practice Address - Street 1:300 NORTH AVENUE
Practice Address - Street 2:BATTLE CREEK HEALTH SYSTEMS EMERGENCY DEPARTMENT
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3307
Practice Address - Country:US
Practice Address - Phone:800-726-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075742207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI53128OtherBCBS MICHIGAN
MI1285673558Medicaid
MI53128OtherBCBS MICHIGAN
MIP53130017Medicare PIN
P00638565Medicare PIN