Provider Demographics
NPI:1952468779
Name:GOSS, CHARLES B (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:B
Last Name:GOSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:28100 GRAND RIVER AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5967
Mailing Address - Country:US
Mailing Address - Phone:248-471-5700
Mailing Address - Fax:248-851-5515
Practice Address - Street 1:28100 GRAND RIVER AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5967
Practice Address - Country:US
Practice Address - Phone:248-471-5700
Practice Address - Fax:248-851-5515
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2008-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MICG0062342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2756329434OtherBLUE CROSS & BLUE SHIELD
MI1091313 11 00Medicaid
MIE31656Medicare UPIN
MI1091313 11 00Medicaid