Individual
HEIDI REBECCA GOEDICKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1921 WALDEMERE ST STE 705, SARASOTA, FL 34239-2913
(941) 366-5864
Mailing address
1921 WALDEMERE ST, SUITE 705, SARASOTA, FL 34239-2943
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
ME123843
FL
207RP1001X
Pulmonary Disease Physician
Primary
ME123843
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014836900
—
FL
01
—
MT194750
MEDICAL TRAINING LICENSE NUMBER
PA
01
—
TRN17847
FLORIDA TRAINING LICENSE
FL
Enumeration date
11/18/2010
Last updated
01/21/2022
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