Judie R. Goodman, DO
Individual provider Active NPI Hematology & Oncology Physician · Pontiac, MI
NPI 1003852732 · NPPES record last updated Sep 28, 2022
Key facts
- NPI
- 1003852732
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Hematology & Oncology Physician 207RH0003X
- License
- 5101007915 (MI)
- Practice address
- Iha Hematology Oncology Oakland
44405 Woodward Avenue, Suite 202
Pontiac, MI 48341-5023 - Phone
- (248) 858-2270
- Fax
- (248) 335-6171
- NPI assigned
- Jun 21, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100604001060 | MI | Practitioner - Internal Medicine |
2365572112 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101007915 | MI | MD | Hematology & Oncology Physician |
| JG007915 | MI | MD | Hematology & Oncology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Iha Olma Specialty Services LLC | Hematology & Oncology | Current |
Accepting new patients |
| SJMH Medical Practice-SMHC | Current |
Accepting new patients | |
| Iha Olma Specialty Services LLC | Current |
Accepting new patients | |
| SJMH Medical Practice-SMHC | Current |
Accepting new patients | |
| Iha Olma Specialty Services LLC | Current | Accepting new patients |
Locations
24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400
5701 Bow Pointe Dr
Ste 335
Clarkston, MI 48346
Phone (248) 338-7171
44405 Woodward Ave
Ste 202
Pontiac, MI 48341
Phone (248) 858-2270
44405 Woodward Ave
Pontiac, MI 48341
Phone (248) 858-3000
1854 W Auburn Rd
Ste 100B
Rochester Hills, MI 48309
Phone (248) 218-9260
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hematology & Oncology Physician | 207RH0003X | JG007915 | MI | |
| Hematology & Oncology Physician | 207RH0003X | 5101007915 | MI | Yes |
Addresses
Primary practice location
Iha Hematology Oncology Oakland
44405 Woodward Avenue, Suite 202
Pontiac, MI 48341-5023
Mailing address
24 Frank Lloyd Wright Drive
Suite J2000
Ann Arbor, MI 48105
Phone (248) 552-0620
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 112933190 | Medicaid | MI |
Other providers in Pontiac, MI
- Mohamad-Hamood Toufik Gomah
- Racheal Gonzalez
- Good Day Counseling LLC
- Good Samaritan Helping Hands
- Beverly Goodman
- Andrew P Gordon
- Lisa Gordon
- William Henry Gordon
- Carol Goubeaux
- Kanika Goyal
All providers in Pontiac, MI · Hematology & Oncology Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.