MEDICARE: ISISS GOODWIN

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	172V00000X	Community Health Worker	UM532479	OH

General Provider Information

NPI Number	:	1780541417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISISS GOODWIN

Provider Business Mailing Address
First Line	:	3286 W 48TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-5934
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3286 W 48TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-5934
Country	:	US
Telephone Number	:	440-691-9746
Fax Number	:

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

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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Directions to “ ISISS GOODWIN ” Practice Location

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