Provider Demographics
NPI:1205013307
Name:MARTIN, CAROLYN GOODRICH (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:GOODRICH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 4TH ST
Mailing Address - Street 2:
Mailing Address - City:KALKASKA
Mailing Address - State:MI
Mailing Address - Zip Code:49646-9506
Mailing Address - Country:US
Mailing Address - Phone:231-258-9586
Mailing Address - Fax:
Practice Address - Street 1:713 4TH ST
Practice Address - Street 2:
Practice Address - City:KALKASKA
Practice Address - State:MI
Practice Address - Zip Code:49646-9506
Practice Address - Country:US
Practice Address - Phone:231-258-9586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049495173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine