Healthcare Provider Details

I. General information

NPI: 1598756595
Provider Name (Legal Business Name): MICHAEL ALLEN GOODEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N WILMOT RD
TUCSON AZ
85712-4498
US

IV. Provider business mailing address

5301 E GRANT RD
TUCSON AZ
85712-2874
US

V. Phone/Fax

Practice location:
  • Phone: 520-324-4220
  • Fax: 520-324-4221
Mailing address:
  • Phone: 520-324-4780
  • Fax: 520-324-2051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number22434
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20030588
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number22434
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number15311
License Number StateND
# 5
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number43665
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: