Provider Demographics
NPI:1427127398
Name:ALAN P GOLDBERG MD PC
Entity type:Organization
Organization Name:ALAN P GOLDBERG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-244-8816
Mailing Address - Street 1:PO BOX 320295
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-0005
Mailing Address - Country:US
Mailing Address - Phone:810-244-8816
Mailing Address - Fax:810-733-8613
Practice Address - Street 1:1284 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3407
Practice Address - Country:US
Practice Address - Phone:810-244-8816
Practice Address - Fax:810-733-8613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047658207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAG3128445OtherDEA
MIB46693Medicare UPIN
MI0P04130Medicare PIN