Provider Demographics
NPI:1821113531
Name:GOETZ, GREGORY G (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:G
Last Name:GOETZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9431 W BELOIT RD
Mailing Address - Street 2:#119
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53227-4367
Mailing Address - Country:US
Mailing Address - Phone:414-881-9185
Mailing Address - Fax:414-727-4056
Practice Address - Street 1:9431 W BELOIT RD
Practice Address - Street 2:#119
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-4367
Practice Address - Country:US
Practice Address - Phone:414-881-9185
Practice Address - Fax:414-727-4056
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2010-11-30
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Provider Licenses
StateLicense IDTaxonomies
WI23351207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine