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MIRANDA A GOODALE, DPM – NPI #1003858762
Surgery, Foot & Ankle

NPI Profile for Dr MIRANDA A GOODALE in BRAZIL, IN.

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Contact Information

MIRANDA A GOODALE, DPM
955 W CRAIG AVE
BRAZIL, IN  47834-7400
 Phone: 812-448-9290
 Fax: 812-448-9296
 Website:
 

Specialty

 Taxonomy Code Specialty Code Provider Type

Surgery, Foot & Ankle

 213ES0103X 48 Podiatry
 

Primary Podiatric Medicine

 213EP1101X 48 Podiatry
Indicates primary specialty

NPI Profile & details for MIRANDA A GOODALE · (Female)

NPI Number 1003858762
Status Active
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 06/10/2006
Last updated 05/31/2019 - About 7 years ago
Sole proprietor 1 No
Identifiers
  • IN License # 07001015A
  • IN Medicaid 200825350A
  • Other 0385202 CIGNA
  • Other 0732240001 DMERC WITH PPG
  • Other 5692086 FIRSTHEALTH
  • IN Other 000000392910 BLUE CROSS BLUE SHIELD
  • IN Other 37278 IHN PPO NETWORK
Hospital affiliation(s)
  • ST VINCENT CLAY HOSPITAL INC - (Critical Access)
    1206 E NATIONAL AVE
    BRAZIL, IN 47834
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.

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