Provider Demographics
NPI:1134227432
Name:GOOD, MICHAEL W (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:GOOD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4414
Practice Address - Street 1:3231 S NATIONAL AVE
Practice Address - Street 2:STE 115
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7304
Practice Address - Country:US
Practice Address - Phone:417-888-5666
Practice Address - Fax:417-890-4174
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-10-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR4J10207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202631362Medicaid
29117OtherBLUE CROSS MO
080174717Medicare PIN
002013162Medicare PIN
MO202631362Medicaid