MEDICARE: DR. MICHAEL G GOODMAN 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
1	207RX0202X	Medical Oncology Physician	8025	MT
2	174400000X	Specialist	8025	MT

General Provider Information

NPI Number	:	1427034834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL G GOODMAN M.D.

Provider Business Mailing Address
First Line	:	107 6TH AVE SW
Second Line	:
City	:	RONAN
State	:	MT
Zip	:	59864-2634
Country	:	US
Telephone Number	:	406-676-4441
Fax Number	:	406-676-0835

Provider Business Practice Location Address
First Line	:	107 6TH AVE SW
Second Line	:
City	:	RONAN
State	:	MT
Zip	:	59864
Country	:	US
Telephone Number	:	406-676-4441
Fax Number	:	406-676-0835

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	06/17/2019

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