Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 5401400121 | MI |
Y | 213ES0103X | Foot & Ankle Surgery | LG400121 | MI |
NPI | 1306925136 |
---|---|
Provider Name | Dr. Lee Kevin Gold |
First Address | West Bloomfield, MI 48322-3263 |
Second Address | Brighton, MI 48116-1998 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 23/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3113590 | (05) | MI |
4894750020 | BCBS NUMBER (01) | MI |
T34302 | (02) | MI |