MEDICARE: KAREN M GOODWIN D.O.

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	208600000X	Surgery Physician	20A13431	CA

General Provider Information

NPI Number	:	1497902308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN M GOODWIN D.O.

Provider Business Mailing Address
First Line	:	3100 SAN PABLO AVE STE 430
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-2498
Country	:	US
Telephone Number	:	415-476-3366
Fax Number	:	510-985-5202

Provider Business Practice Location Address
First Line	:	3100 SAN PABLO AVE STE 430
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-2498
Country	:	US
Telephone Number	:	415-476-3366
Fax Number	:	510-985-5202

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

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	02/25/2020

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