Provider Demographics
NPI:1538135256
Name:GOERKE, PAUL F (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:F
Last Name:GOERKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:24906 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1740
Mailing Address - Country:US
Mailing Address - Phone:313-562-0977
Mailing Address - Fax:313-562-3276
Practice Address - Street 1:24906 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1740
Practice Address - Country:US
Practice Address - Phone:313-562-0977
Practice Address - Fax:313-562-3276
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101005801207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1393510Medicaid
MIB46555Medicare UPIN
MI58221656111Medicare ID - Type Unspecified