Provider Demographics
NPI:1548270788
Name:GOODMAN, MICHAEL LOUIS (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LOUIS
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:PO BOX 2243
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2243
Mailing Address - Country:US
Mailing Address - Phone:850-512-3482
Mailing Address - Fax:850-969-2130
Practice Address - Street 1:1555 N PALAFOX ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-2134
Practice Address - Country:US
Practice Address - Phone:850-512-3482
Practice Address - Fax:850-969-2130
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102142207T00000X
CODR.0040268207T00000X
PAMD027640E207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1548270788Medicaid
FL000222900Medicaid
FL1548270788OtherRR MCR
E99182Medicare UPIN
AL1548270788Medicaid