| Specialty | Taxonomy Code | |
|---|---|---|
| * | Surgical | 363AS0400X |
* Indicates primary specialty
| NPI Number | 1306396759 |
| Credentials | LSA |
| Entity | Individual |
| Enumeration date | 10/10/2016 |
| Last updated | 10/08/2021 - About 5 years ago |
| Sole proprietor1 | Yes |
| Identifiers | n/a |
| Hospital affiliation | n/a |
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.
There are currently no reviews for CHARLES M GOEDECKE, LSA