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NPI Code Detail

MEDICARE: MORGAN GOODMAN

MEDICARE: MORGAN GOODMAN
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
1247200000XOther TechnicianMI
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1538667332
Entity Type Code : Individual
Provider Name (Legal Business Name) : MORGAN GOODMAN
Provider Business Mailing Address
First Line : 3769 QUARTON RD
Second Line :
City : BLOOMFIELD HILLS
State : MI
Zip : 48302-4058
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3769 QUARTON RD
Second Line :
City : BLOOMFIELD HILLS
State : MI
Zip : 48302-4058
Country : US
Telephone Number : 248-894-1966
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2018
Last Update Date : 04/16/2024

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