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General NPI Number Information
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NPI Number | 1043323272
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Entity Type | Organization
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Legal Business Name | BRUCE A. GOBER MD LTD
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 02/19/2016
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Provider Practice Location Address
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Address Line | 3300 N LAKE SHORE DR APT 5A
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City | CHICAGO
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State | IL
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Zip | 60657-3957
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Country | US
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Telephone | 773-213-5016
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 N LAKE SHORE DR APT 5A
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City | CHICAGO
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State | IL
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Zip | 60657-3957
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Country | US
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Telephone | 773-213-5016
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRUCE GOBER
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Credential | M.D.
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Telephone | 773-213-5016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036045996
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License Number State | IL
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