MEDICARE: DR. ROBERT S. GOLDEN 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	207R00000X	Internal Medicine Physician	036086290	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1172487	OTHER	IL	UNITED HEALTHCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4476901	OTHER	IL	AETNA

General Provider Information

NPI Number	:	1992887541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT S. GOLDEN M.D.

Provider Business Mailing Address
First Line	:	201 E HURON ST #12-205
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-3127
Country	:	US
Telephone Number	:	312-944-0688
Fax Number	:	312-944-2886

Provider Business Practice Location Address
First Line	:	201 E HURON ST #12-205
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-3127
Country	:	US
Telephone Number	:	312-944-0688
Fax Number	:	312-944-2886

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	02/26/2015

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