Provider Demographics
NPI:1366963001
Name:GOETHALS, JOSHUA MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MICHAEL
Last Name:GOETHALS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 PATIENT CARE DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4217
Mailing Address - Country:US
Mailing Address - Phone:517-267-0200
Mailing Address - Fax:517-267-1877
Practice Address - Street 1:3404 PATIENT CARE DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4217
Practice Address - Country:US
Practice Address - Phone:517-267-0200
Practice Address - Fax:517-267-1877
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101023604207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery