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General NPI Number Information
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NPI Number | 1669466801
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Entity Type | Individual
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Provider Name | UMESH P GOSWAMI MD
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Gender | Male
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Dates
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Enumeration Date | 09/02/2005
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Last Update Date | 05/12/2017
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Provider Practice Location Address
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Address Line | 599 PEARSON DR
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City | GENOA
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State | IL
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Zip | 60135-1355
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Country | US
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Telephone | 815-784-6437
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Fax | 815-784-3933
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Provider Business Mailing Address
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Address Line | 599 PEARSON DR
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City | GENOA
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State | IL
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Zip | 60135-1355
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Country | US
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Telephone | 815-784-6437
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Fax | 815-784-3933
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036058246
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License Number State | IL
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