Basic Information
Provider Information
NPI: 1427036771
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GOYAL
FirstName: RAVINDRA
MiddleName: N.
NamePrefix:  
NameSuffix:  
Credential: M.D.
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: 4175 N EUCLID AVE
Address2: SUITE 9
City: BAY CITY
State: MI
PostalCode: 487062408
CountryCode: US
TelephoneNumber: 9896673400
FaxNumber: 9896673401
Other Information
ProviderEnumerationDate: 01/06/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207T00000X049663MIY Allopathic & Osteopathic PhysiciansNeurological Surgery 

ID Information
IDTypeStateIssuerDescription
716630701MIAETNAOTHER
09999801MIBAY HEALTH PLANOTHER
101048701MIMHP HANOTHER
CN5519 POO13965401MIMETRAHEALTHOTHER
140090026201MIHEALTHPLUSOTHER
494783705MI MEDICAID
G03672 P6059901MIBCNOTHER


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