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General NPI Number Information
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NPI Number | 1417957226
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Entity Type | Individual
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Provider Name | BRUCE J GOLDBERG M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/22/2005
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 1555 BARRINGTON RD STE 205
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60169-1063
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Country | US
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Telephone | 630-480-0490
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Fax | 630-580-9641
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Provider Business Mailing Address
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Address Line | 1059 W SKYLARK DR
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City | PALATINE
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State | IL
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Zip | 60067-7058
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Country | US
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Telephone | 630-480-0490
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Fax | 630-580-9641
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 036-072948
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License Number State | IL
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