Provider Demographics
NPI:1891793360
Name:GOSWAMI, GUNATEET K (MD)
Entity Type:Individual
Prefix:
First Name:GUNATEET
Middle Name:K
Last Name:GOSWAMI
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 1:43475 DALCOMA DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-3593
Mailing Address - Country:US
Mailing Address - Phone:586-228-2518
Mailing Address - Fax:586-228-2517
Practice Address - Street 1:43475 DALCOMA DR STE 200
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-3593
Practice Address - Country:US
Practice Address - Phone:586-228-2518
Practice Address - Fax:586-228-2517
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073226207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4616638Medicaid
MIOM33200016Medicare PIN
MIG99212Medicare UPIN