Organization
DRS WAGNER GOODMAN PASCH AND PACKMAN LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH JAY GOODMAN MD (PRESIDENT)
(414) 332-1000
Entity
Organization
Contact information
Practice address
5150 N PORT WASHINGTON RD, SUITE 151, MILWAUKEE, WI 53217-5474
(414) 332-1000
(414) 332-1005
Mailing address
5150 N PORT WASHINGTON RD, SUITE 151, MILWAUKEE, WI 53217-5474
(414) 332-1000
(414) 332-1005
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
WI
2086S0129X
Vascular Surgery Physician
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32705400
—
WI
Enumeration date
07/21/2005
Last updated
07/21/2022
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