Healthcare Provider Details

I. General information

NPI: 1811138076
Provider Name (Legal Business Name): GEORGE W. GOODLOW, MD, PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 05/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3295 N ARLINGTON HEIGHTS RD SUITE 106-107
ARLINGTON HEIGHTS IL
60004-1565
US

IV. Provider business mailing address

3295 N ARLINGTON HEIGHTS RD SUITE 107
ARLINGTON HEIGHTS IL
60004-1565
US

V. Phone/Fax

Practice location:
  • Phone: 847-797-0587
  • Fax: 847-797-1020
Mailing address:
  • Phone: 847-797-0587
  • Fax: 847-797-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-050051
License Number StateIL

VIII. Authorized Official

Name: GEORGE W. GOODLOW
Title or Position: OWNER
Credential: MD
Phone: 847-797-0587