Healthcare Provider Details

I. General information

NPI: 1205901816
Provider Name (Legal Business Name): RACHEL GOODMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

572 LINCOLN AVE SUITE # 3
WINNETKA IL
60093-2308
US

IV. Provider business mailing address

572 LINCOLN AVE SUITE # 3
WINNETKA IL
60093-2308
US

V. Phone/Fax

Practice location:
  • Phone: 847-501-4040
  • Fax: 847-501-4075
Mailing address:
  • Phone: 847-501-4040
  • Fax: 847-501-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036093612
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: