Provider Demographics
NPI:1376869404
Name:MICHAEL M GOLD MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MICHAEL M GOLD MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-358-3458
Mailing Address - Street 1:2585 SAMARITAN DR STE 303
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4107
Mailing Address - Country:US
Mailing Address - Phone:408-358-3458
Mailing Address - Fax:408-356-6191
Practice Address - Street 1:2585 SAMARITAN DR STE 303
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4107
Practice Address - Country:US
Practice Address - Phone:408-358-3458
Practice Address - Fax:408-356-6191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30699261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty