Provider Demographics
NPI:1992720684
Name:GOODMAN, NEIL JOSEPH (DO)
Entity type:Individual
Prefix:MR
First Name:NEIL
Middle Name:JOSEPH
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:20095 GILBERT RD
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-2365
Mailing Address - Country:US
Mailing Address - Phone:231-592-1360
Mailing Address - Fax:231-592-1361
Practice Address - Street 1:20095 GILBERT RD
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2365
Practice Address - Country:US
Practice Address - Phone:231-592-1360
Practice Address - Fax:231-592-1361
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101010066207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1999212Medicaid
F38770Medicare UPIN
MI1999212Medicaid