Healthcare Provider Details

I. General information

NPI: 1912160151
Provider Name (Legal Business Name): RUCHIKA GOEL MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W CARPENTER ST FL 1
SPRINGFIELD IL
62702
US

IV. Provider business mailing address

PO BOX 19677
SPRINGFIELD IL
62794-9677
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-545-1141
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-1141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number036-145997
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number036-145997
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: