Healthcare Provider Details

I. General information

NPI: 1457360828
Provider Name (Legal Business Name): NEELAM GOEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 WEST ST BUILDING A SUITE 116
PERU IL
61354-2763
US

IV. Provider business mailing address

622 30TH ST
PERU IL
61354-1472
US

V. Phone/Fax

Practice location:
  • Phone: 815-223-6222
  • Fax: 815-223-3838
Mailing address:
  • Phone: 815-224-4188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: