Provider Demographics
NPI:1326312745
Name:RICHARD N. GOICH D.P.M. P.C.
Entity Type:Organization
Organization Name:RICHARD N. GOICH D.P.M. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:N
Authorized Official - Last Name:GOICH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-774-1180
Mailing Address - Street 1:25630 LITTLE MACK AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-2109
Mailing Address - Country:US
Mailing Address - Phone:586-774-1180
Mailing Address - Fax:586-774-2661
Practice Address - Street 1:25630 LITTLE MACK AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-2109
Practice Address - Country:US
Practice Address - Phone:586-774-1180
Practice Address - Fax:586-774-2661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI000706213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1558363812Medicare PIN
MI1326312745Medicare PIN