Provider Demographics
NPI:1427036771
Name:GOYAL, RAVINDRA N (MD)
Entity Type:Individual
Prefix:
First Name:RAVINDRA
Middle Name:N
Last Name:GOYAL
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 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:4175 N EUCLID AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2408
Practice Address - Country:US
Practice Address - Phone:989-667-3400
Practice Address - Fax:989-667-3401
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI049663207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7166307OtherAETNA
MI099998OtherBAY HEALTH PLAN
MI1010487OtherMHP HAN
MICN5519 POO139654OtherMETRAHEALTH
MI1400900262OtherHEALTHPLUS
MI4947837Medicaid
MIG03672 P60599OtherBCN
MIG03672 P60599OtherBCN
MIA77174Medicare UPIN