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
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 049663 | MI | Y |   | Allopathic & Osteopathic Physicians | Neurological Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 7166307 | 01 | MI | AETNA | OTHER | 099998 | 01 | MI | BAY HEALTH PLAN | OTHER | 1010487 | 01 | MI | MHP HAN | OTHER | CN5519 POO139654 | 01 | MI | METRAHEALTH | OTHER | 1400900262 | 01 | MI | HEALTHPLUS | OTHER | 4947837 | 05 | MI |   | MEDICAID | G03672 P60599 | 01 | MI | BCN | OTHER |