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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

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