Individual
MICHAEL GODDARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
105 HALL ST, TRAVERSE CITY, MI 49684-2288
(231) 922-3850
Mailing address
12800 S SYLVIA ST, TRAVERSE CITY, MI 49684-5357
(231) 357-9612
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704297303
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704297303
REGISTERED NURSE
MI
Enumeration date
09/22/2014
Last updated
09/22/2014
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