Provider Demographics
NPI:1306826615
Name:GOSS, MICHAEL P (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:GOSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6400 INDUSTRIAL LOOP
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-2452
Mailing Address - Country:US
Mailing Address - Phone:414-423-4100
Mailing Address - Fax:414-423-4134
Practice Address - Street 1:19035 W CAPITOL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-2706
Practice Address - Country:US
Practice Address - Phone:262-754-1421
Practice Address - Fax:262-754-3760
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2008-09-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI25934-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31550000Medicaid
WI31550000Medicaid
WI0011Medicare ID - Type Unspecified