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General NPI Number Information
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NPI Number | 1053403162
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Entity Type | Organization
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Legal Business Name | GOLD COAST INTERNAL MEDICINE
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3000 N HALSTED STREET SUITE 303
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City | CHICAGO
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State | IL
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Zip | 60657-5190
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Country | US
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Telephone | 773-525-1900
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Fax | 773-525-1911
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Provider Business Mailing Address
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Address Line | 3000 N HALSTED STREET SUITE 303
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City | CHICAGO
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State | IL
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Zip | 60657-5190
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Country | US
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Telephone | 773-525-1900
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Fax | 773-525-1911
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WALDO EMERSON HARVEY JR.
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Credential | M.D.
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Telephone | 773-525-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | IL
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