Basic Information
| Provider Information | |||||||||
| NPI: | 1720039951 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOOD | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9200 W WISCONSIN AVE | ||||||||
| Address2: | INTERNAL MEDICINE HOSPITALIST | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532263522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148050812 | ||||||||
| FaxNumber: | 4148050855 | ||||||||
| Practice Location | |||||||||
| Address1: | 1155 N MAYFAIR RD | ||||||||
| Address2: | |||||||||
| City: | WAUWATOSA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532263462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4149555990 | ||||||||
| FaxNumber: | 4149556282 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 04/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 31744-20 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 31744 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | MD057253L | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RC0200X | MD057253L | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RH0002X | MD057253L | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | 208M00000X | 31744 | WI | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 0015599400003 | 05 | PA | MEDICAID | 20274 | 01 | PA | GEISINGER HEALTH PLAN | OTHER | 828235 | 01 | PA | HIGHMARK BC/BS | OTHER | 290008338 | 01 | RAILROAD MEDICARE | OTHER | 72476 | 01 | PA | UNISON HEALTH PLAN | OTHER | P000533 | 01 | PA | GATEWAY HEALTH PLAN | OTHER | 1720039951 | 05 | WI | MEDICAID | 203559 | 01 | PA | UPMC HEALTH PLAN | OTHER |