Provider Demographics
NPI:1144224965
Name:GOODMAN, SHEILA ROSENTHAL (MD)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:ROSENTHAL
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6565 FRANCE AVE S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2137
Mailing Address - Country:US
Mailing Address - Phone:952-806-0011
Mailing Address - Fax:952-806-9741
Practice Address - Street 1:6565 FRANCE AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2137
Practice Address - Country:US
Practice Address - Phone:952-806-0011
Practice Address - Fax:952-806-9741
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN34820207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN761898100Medicaid
MN761898100Medicaid
MNF21441Medicare UPIN