Healthcare Provider Details

I. General information

NPI: 1043949258
Provider Name (Legal Business Name): EMILY ANN GOODLIN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 S CICERO AVE
CICERO IL
60804-3638
US

IV. Provider business mailing address

5359 W FULLERTON AVE
CHICAGO IL
60639-1450
US

V. Phone/Fax

Practice location:
  • Phone: 708-780-9777
  • Fax:
Mailing address:
  • Phone: 773-836-2785
  • Fax: 773-836-7381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.173299
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: