Provider Demographics
NPI:1689825788
Name:GOEL, MANUJ (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUJ
Middle Name:
Last Name:GOEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16233 SYLVESTER RD SW STE G60
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3047
Mailing Address - Country:US
Mailing Address - Phone:206-988-5724
Mailing Address - Fax:
Practice Address - Street 1:16233 SYLVESTER RD SW STE G60
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3047
Practice Address - Country:US
Practice Address - Phone:206-988-5724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61387268207Q00000X
WI55969-20207Q00000X
MS22407207Q00000X
IL036138480207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07651507Medicaid
WA2250934Medicaid