Provider Demographics
NPI:1336124890
Name:GOETZ, ANGUS G III (DO)
Entity Type:Individual
Prefix:
First Name:ANGUS
Middle Name:G
Last Name:GOETZ
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 W MITCHELL ST STE 560
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2279
Mailing Address - Country:US
Mailing Address - Phone:231-487-5400
Mailing Address - Fax:
Practice Address - Street 1:560 W MITCHELL ST STE 560
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2279
Practice Address - Country:US
Practice Address - Phone:231-487-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7949A207X00000X
MI5101010937207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4389576Medicaid
MIC20677OtherRAILROAD MEDICARE
MIG03142Medicare UPIN
MIC20677OtherRAILROAD MEDICARE
WYW21955Medicare PIN