| Charles G. Godoshian, M.d., P.c. | |
|
27177 Lahser Rd Suite 104 Southfield MI 48034-4714 | |
| (248) 353-0882 | |
| (248) 353-0883 |
| Full Name | Charles G. Godoshian, M.d., P.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 27177 Lahser Rd, Southfield, Michigan |
| Authorized Official Name and Position | Charles G Godoshian (PRESIDENT) |
| Authorized Official Contact | 2483530882 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charles G. Godoshian, M.d., P.c. 27177 Lahser Rd Suite 104 Southfield MI 48034-4714 Ph: (248) 353-0882 | Charles G. Godoshian, M.d., P.c. 27177 Lahser Rd Suite 104 Southfield MI 48034-4714 Ph: (248) 353-0882 |
| NPI Number | 1215133673 |
|---|---|
| Provider Enumeration Date | 06/22/2007 |
| Last Update Date | 06/02/2009 |
| Medicare PECOS PAC ID | 6305874462 |
|---|---|
| Medicare Enrollment ID | O20050729000720 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215133673 | NPI | - | NPPES |
| 1731411 | Medicaid | MI | |
| 0F38121 | Other | MI | BLUE CROSS BLUE SHIELD OF MICHIGAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | CG046652 (Michigan) | Primary |
| Provider Name | Charles G Godoshian |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699769190 PECOS PAC ID: 8820026990 Enrollment ID: I20050802001202 |
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Ark Health Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 23999 Northwestern Hwy, Southfield, MI 48075 Phone: 248-924-1429 Fax: 248-419-2431 | |
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Magnum Managment Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 17600 W 8 Mile Rd, Suite # 5, Southfield, MI 48075 Phone: 248-424-9749 | |
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