MEDICARE: MICHAEL JOSEPH 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	2085R0001X	Radiation Oncology Physician	43377	GA
2	2085R0001X	Radiation Oncology Physician	01036134	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01036134B	OTHER	IN	CSR

General Provider Information

NPI Number	:	1881748697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JOSEPH GOODMAN MD

Provider Business Mailing Address
First Line	:	5024 OAK PARK CIR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30324-5292
Country	:	US
Telephone Number	:	404-831-3453
Fax Number	:

Provider Business Practice Location Address
First Line	:	5024 OAK PARK CIR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30324-5292
Country	:	US
Telephone Number	:	404-831-3453
Fax Number	:

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	04/26/2023

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