MEDICARE: BRIAN GOODWIN DPM PC

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	332B00000X	Durable Medical Equipment & Medical Supplies	1461520001	MI

General Provider Information

NPI Number	:	1720262637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIAN GOODWIN DPM PC

Provider Business Mailing Address
First Line	:	4737 24 MILE RD
Second Line	:	SUITE 2
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-3148
Country	:	US
Telephone Number	:	248-651-0008
Fax Number	:	248-651-6988

Provider Business Practice Location Address
First Line	:	4737 24 MILE RD
Second Line	:	SUITE 2
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-3148
Country	:	US
Telephone Number	:	248-651-0008
Fax Number	:	248-651-6988

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. DEBRA L MACHIN
Credential	:
Telephone Number	:	248-651-0008

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	02/20/2008

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