NPIMap

Organization Active NPI

Walnut Lake OBGYN PLLC

  • Obstetrics & Gynecology Physician
  • West Bloomfield, MI
National Provider Identifier
1942340187
Registry record updated Jun 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
AG035173 Issued in MI
Legal business name
WALNUT LAKE OBGYN PLLC
Practice address
2300 Haggerty Rd
Ste 2070
West Bloomfield, MI 48323-2184
Phone
(248) 926-2020
Fax
(248) 926-9020
NPI assigned
Feb 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Alan D Goldsmith, MDNPI 1891781795
Title
Partner
Phone
(248) 926-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X AG035173 MI Primary

Addresses

Primary practice location

2300 Haggerty Rd
Ste 2070
West Bloomfield, MI 48323-2184

Mailing address

2300 Haggerty Rd
Ste 2070
West Bloomfield, MI 48323-2190
Phone (248) 926-2020

Other identifiers 2

IdentifierTypeStateIssuer
1600F321780OtherMIBLUE CROSS GROUP PIN
1942340187OtherMINPI

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/26519c41-5760-4666-aec7-131cba00ac7b/

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276819200000",
    "number": "1942340187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 HAGGERTY RD",
            "address_2": "STE 2070",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483232190",
            "telephone_number": "248-926-2020",
            "fax_number": "248-926-9020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 HAGGERTY RD",
            "address_2": "STE 2070",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483232184",
            "telephone_number": "248-926-2020",
            "fax_number": "248-926-9020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALNUT LAKE OBGYN PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2010-06-18",
        "status": "A",
        "authorized_official_last_name": "GOLDSMITH",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "248-926-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "AG035173",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP PIN",
            "identifier": "1600F321780",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1942340187",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Bloomfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.