Provider Demographics
NPI:1528033594
Name:GOLDEN, SANDRA A (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:A
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1455 S LAPEER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1468
Mailing Address - Country:US
Mailing Address - Phone:248-693-3551
Mailing Address - Fax:248-693-4643
Practice Address - Street 1:1455 S. LAPEER RD
Practice Address - Street 2:STE D
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360
Practice Address - Country:US
Practice Address - Phone:248-693-3551
Practice Address - Fax:248-693-4643
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301044877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104823105Medicaid
MI0634808OtherBCBS
MION84830Medicare UPIN