Provider Demographics
NPI:1609139138
Name:GOEDKEN, MICHELLE LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LYNN
Last Name:GOEDKEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:DUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2551 E CALLE SIN RUIDO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-7337
Mailing Address - Country:US
Mailing Address - Phone:269-370-0510
Mailing Address - Fax:520-771-0289
Practice Address - Street 1:1521 E TANGERINE RD STE 161
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-6217
Practice Address - Country:US
Practice Address - Phone:520-771-0288
Practice Address - Fax:520-771-0289
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006346207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery