MEDICARE: DR. JACOB L GOLDING 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	261QA1903X	Ambulatory Surgical Clinic/Center	16396-20	WI

General Provider Information

NPI Number	:	1720413073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB L GOLDING M.D.

Provider Business Mailing Address
First Line	:	7300 N BEACH DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53217-3661
Country	:	US
Telephone Number	:	414-352-1551
Fax Number	:	414-352-1577

Provider Business Practice Location Address
First Line	:	7300 N BEACH DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53217-3661
Country	:	US
Telephone Number	:	414-352-1551
Fax Number	:	414-352-1577

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

Provider Enumeration Date	:	09/05/2013
Last Update Date	:	09/05/2013

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