| Thomas E Goodrich Md Sc | |
|
6015 Durand Ave Suite 500 Mount Pleasant WI 53406-5089 | |
| (262) 456-1000 | |
| (262) 456-1654 |
| Full Name | Thomas E Goodrich Md Sc |
|---|---|
| Speciality | Family Medicine |
| Location | 6015 Durand Ave, Mount Pleasant, Wisconsin |
| Authorized Official Name and Position | Thomas Edward Goodrich (PRESIDENT) |
| Authorized Official Contact | 2624561000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Thomas E Goodrich Md Sc 6015 Durand Ave Suite 500 Mount Pleasant WI 53406-5089 Ph: (262) 456-1000 | Thomas E Goodrich Md Sc 6015 Durand Ave Suite 500 Mount Pleasant WI 53406-5089 Ph: (262) 456-1000 |
| NPI Number | 1679712400 |
|---|---|
| Provider Enumeration Date | 02/18/2009 |
| Last Update Date | 11/25/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679712400 | NPI | - | NPPES |
| 30830700 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 28720 (Wisconsin) | Primary |
| 261QP2300X | Clinic/center - Primary Care | 28720 (Wisconsin) | Secondary |
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