Provider Demographics
NPI:1467422923
Name:GOLDFARB, MICHAEL THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:GOLDFARB
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 1:2051 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2920
Mailing Address - Country:US
Mailing Address - Phone:313-563-1212
Mailing Address - Fax:313-563-6069
Practice Address - Street 1:2051 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2920
Practice Address - Country:US
Practice Address - Phone:313-563-1212
Practice Address - Fax:313-563-6069
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045024207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1650547Medicaid
MI0824527Medicare ID - Type Unspecified
MI1650547Medicaid