Healthcare Provider Details

I. General information

NPI: 1386110369
Provider Name (Legal Business Name): THOMAS JOHN GOEBIG JR. H.I.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 45TH ST STE 205
MUNSTER IN
46321-3958
US

IV. Provider business mailing address

5202 WASHINGTON ST APT 403
DOWNERS GROVE IL
60515-4743
US

V. Phone/Fax

Practice location:
  • Phone: 219-243-8077
  • Fax:
Mailing address:
  • Phone: 773-485-5385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number17001502A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: