Provider Demographics
NPI:1417118332
Name:GOLDIN, MICHAEL S
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:GOLDIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38690 STIVERS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-5279
Mailing Address - Country:US
Mailing Address - Phone:510-248-1040
Mailing Address - Fax:
Practice Address - Street 1:38690 STIVERS ST
Practice Address - Street 2:ST. #A
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5279
Practice Address - Country:US
Practice Address - Phone:510-248-1040
Practice Address - Fax:510-797-7426
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112109208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ70467OtherREGISTERED AS A RESIDENT - STATE OF ARIZONA