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General NPI Number Information
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NPI Number | 1427353184
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Entity Type | Organization
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Legal Business Name | RICHARD S. GOLDBERG, M.D., LTD.
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Dates
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Enumeration Date | 01/11/2011
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Last Update Date | 01/11/2011
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Provider Practice Location Address
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Address Line | 8311 ROOSEVELT RD OPTIONAL
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City | FOREST PARK
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State | IL
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Zip | 60130-2529
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Country | US
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Telephone | 708-814-6600
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Fax | 630-920-9095
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Provider Business Mailing Address
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Address Line | 8311 ROOSEVELT RD OPTIONAL
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City | FOREST PARK
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State | IL
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Zip | 60130-2529
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Country | US
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Telephone | 708-814-6600
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Fax | 630-920-9095
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD GOLDBERG
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Credential | MD
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Telephone | 708-814-6600
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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 | 036056868
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License Number State | IL
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