MEDICARE: ERIC M GODREAU 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	2085R0202X	Diagnostic Radiology Physician	ME83134	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831120484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC M GODREAU M.D.

Provider Business Mailing Address
First Line	:	PO BOX 491316
Second Line	:
City	:	KEY BISCAYNE
State	:	FL
Zip	:	33149-7316
Country	:	US
Telephone Number	:	305-298-1333
Fax Number	:

Provider Business Practice Location Address
First Line	:	1380 NE MIAMI GARDENS DR
Second Line	:	#115
City	:	MIAMI
State	:	FL
Zip	:	33179-4707
Country	:	US
Telephone Number	:	305-947-4461
Fax Number	:

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	11/23/2009

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Directions to “ ERIC M GODREAU M.D.” Practice Location

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