Healthcare Provider Details

I. General information

NPI: 1891868709
Provider Name (Legal Business Name): MATTHEW BRENT GOREN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TWO PRUDENTIAL PLAZA SUITE 3175
CHICAGO IL
60601-6719
US

IV. Provider business mailing address

TWO PRUDENTIAL PLAZA SUITE 3175
CHICAGO IL
60601-6719
US

V. Phone/Fax

Practice location:
  • Phone: 312-332-2262
  • Fax: 312-819-1316
Mailing address:
  • Phone: 312-332-2262
  • Fax: 312-819-1316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: