MEDICARE: ROBERT GOODE, PH.D. PLLC

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	251S00000X	Community/Behavioral Health Agency	6301013742	MI

General Provider Information

NPI Number	:	1790936516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT GOODE, PH.D. PLLC

Provider Business Mailing Address
First Line	:	2035 HOGBACK RD
Second Line	:	SUITE 102
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-9732
Country	:	US
Telephone Number	:	734-223-4202
Fax Number	:

Provider Business Practice Location Address
First Line	:	2035 HOGBACK RD
Second Line	:	SUITE 102
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-9732
Country	:	US
Telephone Number	:	734-223-4202
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT LYNTON GOODE
Credential	:	PH.D.
Telephone Number	:	734-223-4202

Provider Enumeration Date	:	10/10/2008
Last Update Date	:	10/10/2008

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