Provider Demographics
NPI:1679544415
Name:GOSWAMI, RAMSEWAK (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMSEWAK
Middle Name:
Last Name:GOSWAMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAM
Other - Middle Name:
Other - Last Name:GOSWAMI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12701 TELEGRAPH RD
Mailing Address - Street 2:SUIUTE 103
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-6847
Mailing Address - Country:US
Mailing Address - Phone:734-374-0500
Mailing Address - Fax:734-374-2415
Practice Address - Street 1:12701 TELEGRAPH RD
Practice Address - Street 2:SUIUTE 103
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180
Practice Address - Country:US
Practice Address - Phone:734-374-0500
Practice Address - Fax:734-374-2415
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301036966207Q00000X
CA155031207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00262129OtherRR MEDICARE
MI1679544415Medicaid
MI0824706OtherBCBSM PIN
MI1679544415Medicaid
MI700H222490OtherBLUE SHIELD