MEDICARE: MICHAEL GOLDMAN 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	207Q00000X	Family Medicine Physician	5203	AZ
2	207Q00000X	Family Medicine Physician	30642	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00435437	OTHER	AZ	RAIL ROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1366426074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL GOLDMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	520-795-6183
Fax Number	:	520-795-6361

Provider Business Practice Location Address
First Line	:	2355 N WYATT DR STE 101
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-2120
Country	:	US
Telephone Number	:	520-616-4948
Fax Number	:	520-616-4958

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	08/15/2024

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Directions to “ MICHAEL GOLDMAN MD” Practice Location

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