Provider Demographics
NPI:1568797348
Name:GOLDMAN, MARILYN BARBARA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:BARBARA
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:GOLDMAN-MINKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6800E 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CENTER LINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015-1167
Mailing Address - Country:US
Mailing Address - Phone:586-756-7777
Mailing Address - Fax:810-458-4187
Practice Address - Street 1:1370 N OAKLAND BLVD
Practice Address - Street 2:1ST FLOOR, SUITE 120
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-4525
Practice Address - Country:US
Practice Address - Phone:248-618-3920
Practice Address - Fax:248-618-3953
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089099207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI427660Medicaid
OE01067Medicare UPIN