Provider Demographics
NPI:1881759868
Name:GOLDBERGER, JAN MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:MICHAEL
Last Name:GOLDBERGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10420 SWAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48609-9117
Mailing Address - Country:US
Mailing Address - Phone:989-781-2381
Mailing Address - Fax:989-781-5118
Practice Address - Street 1:10420 SWAN CREEK RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48609-9117
Practice Address - Country:US
Practice Address - Phone:989-781-2381
Practice Address - Fax:989-781-5118
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007063207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI010Z911030OtherBLUE CROSS BLUE SHIELD
MI60737AOtherHEALTH ALLIANCE PLAN
MI0Z96017OtherMEDICARE PTAN
MI010E660190OtherBCBS
MI5189266Medicaid
MI5189275Medicaid
MI010Z960170OtherBLUE CROSS BLUE SHIELD
MI5176043Medicaid
MI1954041Medicaid
MIAF09001OtherMCARE
MI0E66019OtherMEDICARE GROUP
MI102453OtherGOOD HEALTH MICHIGAN
MIJG007063OtherBCBS
MIQMP000003387413OtherMOLINA HEALTH CARE
MI60737AOtherHEALTH ALLIANCE PLAN
MIE66019084Medicare PIN
MIZ96017038Medicare PIN
MI010Z911030OtherBLUE CROSS BLUE SHIELD
MIJG007063OtherBCBS