MEDICARE: DR. LARRY SCOTT GOLDMAN 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	2084P0800X	Psychiatry Physician	036-059116	IL

Other Identifiers

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

General Provider Information

NPI Number	:	1851356752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY SCOTT GOLDMAN M.D.

Provider Business Mailing Address
First Line	:	1 E ERIE ST STE 355
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2772
Country	:	US
Telephone Number	:	312-573-0900
Fax Number	:	312-573-1532

Provider Business Practice Location Address
First Line	:	1 E ERIE ST
Second Line	:	SUITE 355
City	:	CHICAGO
State	:	IL
Zip	:	60611-2740
Country	:	US
Telephone Number	:	312-573-0900
Fax Number	:	312-573-1532

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

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	01/16/2012

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