Healthcare Provider Details

I. General information

NPI: 1356431720
Provider Name (Legal Business Name): RICHARD STUART GOLDBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 10/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8311 ROOSEVELT RD
FOREST PARK IL
60130-2529
US

IV. Provider business mailing address

PO BOX 5230
RIVER FOREST IL
60305-5230
US

V. Phone/Fax

Practice location:
  • Phone: 708-814-6600
  • Fax: 708-209-2283
Mailing address:
  • Phone: 708-814-6600
  • Fax: 630-920-9095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number036056868
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number036056868
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036056868
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: