Provider Demographics
NPI:1497755177
Name:GOLDFARB, STEPHEN B (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:B
Last Name:GOLDFARB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 INKSTER RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2577
Mailing Address - Country:US
Mailing Address - Phone:734-522-0404
Mailing Address - Fax:734-522-0835
Practice Address - Street 1:6255 INKSTER RD
Practice Address - Street 2:SUITE 105
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2577
Practice Address - Country:US
Practice Address - Phone:734-522-0404
Practice Address - Fax:734-522-0835
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISB006197207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1705073Medicaid
MI5823242Medicare ID - Type Unspecified
MI1705073Medicaid