Healthcare Provider Details

I. General information

NPI: 1902069412
Provider Name (Legal Business Name): ADAM GOLDKIND DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 BARRINGTON RD STE 305
HOFFMAN ESTATES IL
60169-5019
US

IV. Provider business mailing address

960 KING RICHARDS CT
DEERFIELD IL
60015-2627
US

V. Phone/Fax

Practice location:
  • Phone: 847-310-8100
  • Fax: 847-310-8156
Mailing address:
  • Phone: 847-309-5236
  • Fax: 847-310-8156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSTUDENT
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016.005406
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: