Individual
MICHAEL GOSHORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6609 W GREENFIELD AVE, WEST ALLIS, WI 53214-4958
(414) 257-8500
(414) 257-8505
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
125-068084
IL
207Q00000X
Family Medicine Physician
Primary
71165
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100089112
—
WI
Enumeration date
05/12/2016
Last updated
06/17/2025
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