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NPI Code Detail

MEDICARE: MICHAEL CHARLES GOLDBACH M.D.

MEDICARE: MICHAEL CHARLES GOLDBACH M.D.
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
1390200000XStudent in an Organized Health Care Education/Training ProgramTRN15004FL
22086S0129XVascular Surgery PhysicianME125075FL

Other Identifiers

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

General Provider Information

NPI Number : 1225359904
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL CHARLES GOLDBACH M.D.
Provider Business Mailing Address
First Line : 2809 W WATERS AVE
Second Line :
City : TAMPA
State : FL
Zip : 33614-1852
Country : US
Telephone Number : 813-348-9088
Fax Number :
Provider Business Practice Location Address
First Line : 2809 W WATERS AVE
Second Line :
City : TAMPA
State : FL
Zip : 33614-1852
Country : US
Telephone Number : 813-348-9088
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2010
Last Update Date : 03/17/2018

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