Provider Demographics
NPI:1841299773
Name:GOODMAN, JOSEPH JAY (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JAY
Last Name:GOODMAN
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 1:5150 N PORT WASHINGTON RD
Mailing Address - Street 2:SUITE 151
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5474
Mailing Address - Country:US
Mailing Address - Phone:414-332-1000
Mailing Address - Fax:414-332-1005
Practice Address - Street 1:5150 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE 151
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-5474
Practice Address - Country:US
Practice Address - Phone:414-332-1000
Practice Address - Fax:414-332-1005
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17918208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32705400Medicaid
WIB53151Medicare UPIN
WI32705400Medicaid
WI020014442Medicare PIN