Basic Information
Provider Information
NPI: 1306834429
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GOLEBA
FirstName: MARIA
MiddleName: E
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 401 S BALLENGER HWY
Address2:  
City: FLINT
State: MI
PostalCode: 485323638
CountryCode: US
TelephoneNumber: 8103421000
FaxNumber: 8103421590
Practice Location
Address1: 10080 E LIPPINCOTT BLVD
Address2:  
City: DAVISON
State: MI
PostalCode: 484239151
CountryCode: US
TelephoneNumber: 8106531130
FaxNumber: 8106588589
Other Information
ProviderEnumerationDate: 10/12/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X4301063362MIY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
20437401MIMCLAREN HEALTH PLANOTHER
098000001MIHEALTH PLUSOTHER
535854801MIAETNAOTHER
G4773701MIHEATLHNETOTHER
20437401MIHEALTH ADVANTAGE NETWORKOTHER
336046605MI MEDICAID
727363400101MICIGNAOTHER
110250323201MIBLUE CROSS BLUE SHIELDOTHER
C584701MIMCAREOTHER


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