Organization
THOMAS E GOODRICH MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS EDWARD GOODRICH M.D. (PRESIDENT)
(262) 456-1000
Entity
Organization
Contact information
Practice address
6015 DURAND AVE, SUITE 500, MOUNT PLEASANT, WI 53406-5089
(262) 456-1000
(262) 456-1654
Mailing address
6015 DURAND AVE, SUITE 500, MOUNT PLEASANT, WI 53406-5089
(262) 456-1000
(262) 456-1654
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
28720
WI
261QP2300X
Primary Care Clinic/Center
28720
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30830700
—
WI
Enumeration date
02/18/2009
Last updated
11/25/2014
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