Organization
GLACIER ONCOLOGY, PLLC
Active
Other names
Michael G Goodman, M.D.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL G GOODMAN M.D. (SOLE PROPRIETOR)
(406) 752-7600
Entity
Organization
Contact information
Practice address
75 CLAREMONT ST, SUITE E, KALISPELL, MT 59901-3585
(406) 752-7600
(406) 752-7614
Mailing address
75 CLAREMONT ST, SUITE E, KALISPELL, MT 59901-3585
(406) 752-7600
(406) 752-7614
Taxonomy
Speciality
Code
Description
License number
State
261QX0200X
Oncology Clinic/Center
Primary
8025
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0105825
—
MT
01
—
011071
BLUE CROSS BLUE SHIELD
MT
01
—
830004450
RAILROAD MEDICARE
MT
Enumeration date
08/13/2008
Last updated
08/13/2008
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