Healthcare Provider Details

I. General information

NPI: 1619053402
Provider Name (Legal Business Name): ELIEEN Z GOOD MWF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4259 S BERKELEY AVE
CHICAGO IL
60653-3030
US

IV. Provider business mailing address

1276 N CLYBOURN
CHICAGO IL
60610
US

V. Phone/Fax

Practice location:
  • Phone: 773-268-7600
  • Fax: 773-268-9088
Mailing address:
  • Phone: 312-337-1073
  • Fax: 312-337-7616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: