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Individual
SUSAN MAVIS GOLTZ
Active
Individual
SUSAN MAVIS GOLTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
33349
MN
207V00000X
Obstetrics & Gynecology Physician
Primary
33349
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0725685
MEDICA
—
01
—
111079
UCARE
MN
05
—
2055782400
—
MN
01
—
2F932SW
BLUE CROSS BLUE SHIELD
MN
05
—
31754000
—
WI
01
—
346005
PREFERRED ONE
—
01
—
A005
TRICARE
—
01
—
HP22608
HEALTH PARTNERS
MN
Enumeration date
03/15/2006
Last updated
12/04/2020
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