Provider Demographics
NPI:1346788254
Name:GOLBERG, ALEKSANDR
Entity type:Individual
Prefix:
First Name:ALEKSANDR
Middle Name:
Last Name:GOLBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30028 W 12 MILE RD
Mailing Address - Street 2:SUITE 31
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3916
Mailing Address - Country:US
Mailing Address - Phone:917-797-3090
Mailing Address - Fax:
Practice Address - Street 1:30028 W 12 MILE RD
Practice Address - Street 2:SUITE 31
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3916
Practice Address - Country:US
Practice Address - Phone:917-797-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization