Healthcare Provider Details

I. General information

NPI: 1487654190
Provider Name (Legal Business Name): BRUCE GOLDBERG MD S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 BARRINGTON RD STE 205
HOFFMAN ESTATES IL
60169-1063
US

IV. Provider business mailing address

1059 W SKYLARK DR
PALATINE IL
60067-7058
US

V. Phone/Fax

Practice location:
  • Phone: 630-480-0490
  • Fax: 630-580-9641
Mailing address:
  • Phone: 630-480-0490
  • Fax: 630-580-9641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: BRUCE J GOLDBERG
Title or Position: OWNER
Credential: M.D.
Phone: 630-480-0490