Provider Demographics
NPI:1669402764
Name:GOLDBERG, MICHAEL DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3808 W RIVERSIDE DR
Mailing Address - Street 2:SUITE # 307
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4325
Mailing Address - Country:US
Mailing Address - Phone:818-524-2222
Mailing Address - Fax:818-524-2221
Practice Address - Street 1:3808 W RIVERSIDE DR
Practice Address - Street 2:SUITE # 307
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4325
Practice Address - Country:US
Practice Address - Phone:818-524-2222
Practice Address - Fax:818-524-2221
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA49409207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A494091Medicaid
CAF51349Medicare UPIN
CA00A494091Medicaid