Provider Demographics
NPI:1669446050
Name:GOYAL, VINOD (MD)
Entity Type:Individual
Prefix:
First Name:VINOD
Middle Name:
Last Name:GOYAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6576 CHELSEA BRG
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3072
Mailing Address - Country:US
Mailing Address - Phone:248-478-5234
Mailing Address - Fax:248-478-5307
Practice Address - Street 1:2141 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4128
Practice Address - Country:US
Practice Address - Phone:313-259-9075
Practice Address - Fax:313-259-3722
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064216207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4708041Medicaid
MI4708041Medicaid
0P13440Medicare PIN