Provider Demographics
NPI:1558363812
Name:GOICH, RICHARD N (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:N
Last Name:GOICH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
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:
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000706213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00438777OtherRAILROAD MEDICARE
MIP00438777OtherRAILROAD MEDICARE
T34214Medicare UPIN