Provider Demographics
NPI:1508158759
Name:GOLDSTEIN, MICHAEL JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAY
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2667 BIRCH HARBOR LN
Mailing Address - Street 2:483-109-750
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-1905
Mailing Address - Country:US
Mailing Address - Phone:248-568-3260
Mailing Address - Fax:
Practice Address - Street 1:1251 JOSLYN AVE
Practice Address - Street 2:483-109-750
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-2064
Practice Address - Country:US
Practice Address - Phone:248-857-3524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2016-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010554882083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine