Individual
GARY S GOLDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1421 PREMIERE DR, MANKATO CLINIC@ WICKERSHAM CAMPUS, MANKATO, MN 56001-6076
(507) 625-1811
Mailing address
PO BOX 8674, 1230 E MAIN ST MANKATO CLINIC LTD, MANKATO, MN 56002-8674
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
43508
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0568394
MEDICAID
IA
01
—
140754
UCARE
MN
01
—
1808800
AMERICAS PPO
MN
01
—
1900310
MEDICA
MN
01
—
340019399
RR MEDICARE
—
05
—
392183200
—
MN
01
—
47D36GO
BCBS
MN
01
—
HP34028
HEALTH PARTNERS
MN
01
—
NA2951028013
PREFFERED ONE
MN
Enumeration date
01/09/2006
Last updated
07/10/2020
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