Basic Information
| Provider Information | |||||||||
| NPI: | 1952863367 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOODIN | ||||||||
| FirstName: | PATRICK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1130 WEST MICHIGAN STREET | ||||||||
| Address2: | FESLER HALL 204 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462025209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172740076 | ||||||||
| FaxNumber: | 3172740256 | ||||||||
| Practice Location | |||||||||
| Address1: | 340 W 10TH ST # 6200 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462023082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172740076 | ||||||||
| FaxNumber: | 3172740256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2019 | ||||||||
| LastUpdateDate: | 06/26/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.