Healthcare Provider Details

I. General information

NPI: 1851547194
Provider Name (Legal Business Name): CARMEL LYNN GOUDZWAARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N. WINFIELD RD.
WINFIELD IL
60190-1295
US

IV. Provider business mailing address

25 N. WINFIELD RD.
WINFIELD IL
60190-1295
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-4700
  • Fax: 630-933-4427
Mailing address:
  • Phone: 630-933-4700
  • Fax: 630-933-4427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036123732
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036123732
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036123732
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: