Healthcare Provider Details

I. General information

NPI: 1083670665
Provider Name (Legal Business Name): CHERYL R GOECKERMANN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 TUTTLE ST
BARABOO WI
53913-3319
US

IV. Provider business mailing address

1700 TUTTLE ST
BARABOO WI
53913-3319
US

V. Phone/Fax

Practice location:
  • Phone: 608-355-3800
  • Fax: 608-355-7001
Mailing address:
  • Phone: 608-355-3800
  • Fax: 608-355-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38184-020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number38184-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: