Provider Demographics
NPI:1922207703
Name:GOESSL, STEVEN J
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:GOESSL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W7417 PINE AVENUE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-9724
Mailing Address - Country:US
Mailing Address - Phone:715-678-2030
Mailing Address - Fax:715-678-2137
Practice Address - Street 1:W7417 PINE AVENUE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-9724
Practice Address - Country:US
Practice Address - Phone:715-678-2030
Practice Address - Fax:715-678-2137
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41434600Medicaid