Provider Demographics
NPI:1881467967
Name:GOODMAN, MADISON LEIGH (PA-S)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:LEIGH
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:LEIGH
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:343 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:343 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2217
Practice Address - Country:US
Practice Address - Phone:734-995-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program