MEDICARE: DR. JOHN D GOLDENBERG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	01048458A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	266180H71	OTHER	IN	INDIVIDUAL MEDICARE PTAN
3	Q00256328	OTHER	IN	RAILROAD MEDICARE
4	040011990	OTHER	IN	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295882280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN D GOLDENBERG M.D.

Provider Business Mailing Address
First Line	:	10201 N ILLINOIS ST STE 110
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46290-1172
Country	:	US
Telephone Number	:	317-844-7059
Fax Number	:	317-819-0044

Provider Business Practice Location Address
First Line	:	11725 ILLINOIS ST
Second Line	:	SUITE 445
City	:	CARMEL
State	:	IN
Zip	:	46032-3010
Country	:	US
Telephone Number	:	317-844-7059
Fax Number	:	317-819-0044

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	06/21/2024

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Directions to “ DR. JOHN D GOLDENBERG M.D.” Practice Location

Language	Start Address	Practice Location

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