Goltz, Susan Mavis

Goltz, Susan Mavis is an individual health care provider with primary practice located at 1000 E 1St St Ste. Ll, Duluth MN 55805-2297. She recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Obstetrics & Gynecology. Allopathic & Osteopathic Physicians / Obstetrics & Gynecology is her primary health care specialty. Goltz, Susan Mavis can be contacted via phone (218) 722-5629.

Contact Information

Primary practice address
1000 E 1St St Ste. Ll Duluth MN 55805-2297
Phone: (218) 722-5629
Fax: (218) 722-5148
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 33349 Minnesota
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 33349 Minnesota

Profile Details

NPI number 1811966500
LBN Legal business name Goltz, Susan Mavis
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 15th, 2006
Last updated Dec 4th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1811966500 NPPES
Minnesota Other 111079 UCARE
Minnesota MEDICAID 31754000 UCARE
Minnesota Other A005 UCARE
Minnesota MEDICAID 2055782400 UCARE
Minnesota Other 0725685 UCARE
Minnesota Other 2F932SW UCARE
Minnesota Other 346005 UCARE
Minnesota Other HP22608 UCARE

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