MEDICARE: DR. BRIAN LAWRENCE GOODWIN DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	5901400156	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	485505278	OTHER	BX
3	4661520001	OTHER	DMERK

General Provider Information

NPI Number	:	1124027321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN LAWRENCE GOODWIN DPM

Provider Business Mailing Address
First Line	:	8175 CARPATHIAN DR
Second Line	:
City	:	WHITE LAKE
State	:	MI
Zip	:	48386-4554
Country	:	US
Telephone Number	:	248-860-5769
Fax Number	:

Provider Business Practice Location Address
First Line	:	4737 24 MILE RD
Second Line	:	SUITE 2
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-3148
Country	:	US
Telephone Number	:	248-651-0008
Fax Number	:	248-651-6988

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	04/21/2016

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