Individual
DR. MIRANDA ANNE GOODALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
955 W CRAIG AVE, BRAZIL, IN 47834-7400
(812) 448-9290
(812) 448-9296
Mailing address
955 W CRAIG AVE, BRAZIL, IN 47834-7400
(812) 448-9290
(812) 448-9296
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
07001015A
IN
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
07001015A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000392910
BLUE CROSS BLUE SHIELD
IN
01
—
0385202
CIGNA
—
01
—
0732240001
DMERC WITH PPG
—
05
—
200825350A
—
IN
01
—
37278
IHN PPO NETWORK
IN
01
—
5692086
FIRSTHEALTH
—
Enumeration date
06/10/2006
Last updated
05/31/2019
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