Provider Demographics
NPI:1932162658
Name:GOLDMAN, ALLAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:L
Last Name:GOLDMAN
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 1:2801 W. KK RIVER PRKWY
Mailing Address - Street 2:SUITE 375
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3678
Mailing Address - Country:US
Mailing Address - Phone:414-672-8550
Mailing Address - Fax:414-672-8551
Practice Address - Street 1:2801 W KK RIVER PRKWY
Practice Address - Street 2:SUITE 375
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3678
Practice Address - Country:US
Practice Address - Phone:414-672-8550
Practice Address - Fax:414-672-8551
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17900207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30906400Medicaid
WI028550003Medicare ID - Type Unspecified
WI30906400Medicaid
WIB53129Medicare UPIN