Healthcare Provider Details

I. General information

NPI: 1922087790
Provider Name (Legal Business Name): SUSAN MICHELLE MILJKOVIC-GOODRICH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 E WASHINGTON ST SUITE 6-C
MEDINA OH
44256-3332
US

IV. Provider business mailing address

970 E WASHINGTON ST SUITE 6-C
MEDINA OH
44256-3332
US

V. Phone/Fax

Practice location:
  • Phone: 330-722-3083
  • Fax: 330-725-5043
Mailing address:
  • Phone: 330-722-3083
  • Fax: 330-725-5043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number35-082575M
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: