Healthcare Provider Details

I. General information

NPI: 1013077346
Provider Name (Legal Business Name): DR. SARITA GOYAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 N SAYRE AVE
CHICAGO IL
60707-3838
US

IV. Provider business mailing address

1920 N SAYRE AVE
CHICAGO IL
60707-3838
US

V. Phone/Fax

Practice location:
  • Phone: 773-745-7305
  • Fax:
Mailing address:
  • Phone: 773-745-7305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: