Provider Demographics
NPI:1003852732
Name:GOODMAN, JUDIE R (DO)
Entity Type:Individual
Prefix:
First Name:JUDIE
Middle Name:R
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:SUITE J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:248-552-0620
Mailing Address - Fax:248-552-0286
Practice Address - Street 1:IHA HEMATOLOGY ONCOLOGY OAKLAND
Practice Address - Street 2:44405 WOODWARD AVENUE, SUITE 202
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5023
Practice Address - Country:US
Practice Address - Phone:248-858-2270
Practice Address - Fax:248-335-6171
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2022-09-28
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Provider Licenses
StateLicense IDTaxonomies
MIJG007915207RH0003X
MI5101007915207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI112933190Medicaid
MI0M75300006Medicare ID - Type Unspecified
MI112933190Medicaid