Organization
MINI B GODDARD M D P C
Active
Organization
MINI B GODDARD M D P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MINI B GODDARD M.D. (PRESIDENT)
(734) 479-7800
Entity
Organization
Contact information
Practice address
14600 KING RD, SUITE A, RIVERVIEW, MI 48193-7952
(734) 479-7800
(734) 479-7802
Mailing address
14600 KING RD, SUITE A, RIVERVIEW, MI 48193-7952
(734) 479-7800
(734) 479-7802
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
4301064837
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2508232231
BCBSM
MI
05
—
4682722
—
MI
Enumeration date
01/23/2007
Last updated
08/22/2020
Update your record
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