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General NPI Number Information
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NPI Number | 1144340308
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Entity Type | Organization
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Legal Business Name | J I GOLDMAN MD PC
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 12/16/2009
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Provider Practice Location Address
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Address Line | 4646 N MARINE DR B 125
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City | CHICAGO
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State | IL
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Zip | 60640-5759
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Country | US
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Telephone | 773-572-0032
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Fax | 773-572-0029
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Provider Business Mailing Address
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Address Line | 33 W ONTARIO ST APT 36B
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City | CHICAGO
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State | IL
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Zip | 60654-7771
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Country | US
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Telephone | 312-787-4916
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAROSLAV GOLDMAN
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Credential | M,D,
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Telephone | 312-787-4916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036100764
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License Number State | IL
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