Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 35.121150 | OH |
N | 208000000X | Pediatrician | 2010017220 | MO |
NPI | 1013229814 |
---|---|
Provider Name | Michael Goodman |
First Address | Columbus, OH 43220-2967 |
Second Address | Westerville, OH 43081-8095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2010 |
Last Update Date | 30/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0231560 | (05) | OH |