Provider Demographics
NPI:1336348002
Name:GREGORY E. GOULD DO PC
Entity type:Organization
Organization Name:GREGORY E. GOULD DO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-853-0800
Mailing Address - Street 1:60005 CAMPGROUND RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-3445
Mailing Address - Country:US
Mailing Address - Phone:586-372-3500
Mailing Address - Fax:586-372-3503
Practice Address - Street 1:60005 CAMPGROUND RD
Practice Address - Street 2:SUITE 600
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48094-3445
Practice Address - Country:US
Practice Address - Phone:586-372-3500
Practice Address - Fax:586-372-3503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015338207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MII49993Medicare UPIN
MIP2828002Medicare PIN
MI0P28280Medicare PIN