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Dr. Charles G Godoshian
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NPI Number Detailed Information
Provider Information:
| Name: | Dr. Charles G Godoshian |
| Gender: | M |
| Provider License Number If Given: | CG046652 |
NPI Information:
| NPI: | 1699769190 |
| Entity Type (Individual or Organization): |
1-ind |
| Enumeration Date: | 9/12/2005 |
| Last Update Date: | 11/1/2011 |
Provider Business Mailing Address:
| Address: | 27177 LAHSER RD SUITE 104 Southfield, MI 48034 |
| Phone Number: | 2483530882 |
| Fax Number: | 2483530883 |
Provider Business Practice Location Address:
| Address: | 27177 LAHSER RD SUITE 104 Southfield, MI 48034 |
| Phone Number: | 2483530882 |
| Fax Number: | 2483530883 |
Provider Taxonomy:
| Primary: | 207R00000X |
| Secondary (if any): | |
| State: | MI |
