Doctor Name: | DR. MIRANDA ANNE GOODALE |
NPI Number: | 1003858762 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DPM |
License Number: | 07001015A |
Business Practice Address: | 1214 E National Ave Suite 130 Brazil, IN - 478342700 |
Business Phone Number: | 8124489290 |
Business Fax Number: | 8124489296 |
Mailing Address: | 1214 E National Ave, Suite 130 BRAZIL |
State: | IN |
Postal Code: | 478342700 |
Phone Number: | 8124489290 |
Fax Number: | 8124489296 |
NPI Enumeration Date: | 06/10/2006 |
NPI Last Update Date: | 03/23/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 07001015A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |