Basic Information
| Provider Information | |||||||||
| NPI: | 1568587202 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RL GOETHKE MD SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8031 | ||||||||
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| City: | APPLETON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549128031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8663130337 | ||||||||
| FaxNumber: | 9207390124 | ||||||||
| Practice Location | |||||||||
| Address1: | 1818 N MEADE ST | ||||||||
| Address2: | |||||||||
| City: | APPLETON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549113454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9207314101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 11/22/2011 | ||||||||
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| AuthorizedOfficialLastName: | GOETHKE | ||||||||
| AuthorizedOfficialFirstName: | RANDAL | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9207314101 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | WI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.