MEDICARE: DR. JOSEPH JAY GOODMAN MD

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	208600000X	Surgery Physician	17918	WI
2	2086S0129X	Vascular Surgery Physician	17918	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841299773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH JAY GOODMAN MD

Provider Business Mailing Address
First Line	:	5150 N PORT WASHINGTON RD
Second Line	:	SUITE 151
City	:	MILWAUKEE
State	:	WI
Zip	:	53217-5474
Country	:	US
Telephone Number	:	414-332-1000
Fax Number	:	414-332-1005

Provider Business Practice Location Address
First Line	:	5150 N PORT WASHINGTON RD
Second Line	:	SUITE 151
City	:	MILWAUKEE
State	:	WI
Zip	:	53217-5474
Country	:	US
Telephone Number	:	414-332-1000
Fax Number	:	414-332-1005

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	09/14/2011

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Directions to “ DR. JOSEPH JAY GOODMAN MD” Practice Location

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