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General NPI Number Information
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NPI Number | 1992006928
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Entity Type | Organization
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Legal Business Name | ALAN H. GOLDBERG, M.D.,S.C.
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Dates
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Enumeration Date | 11/08/2010
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Last Update Date | 11/08/2010
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Provider Practice Location Address
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Address Line | 845 N MICHIGAN AVE #977W
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City | CHICAGO
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State | IL
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Zip | 60611-2252
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Country | US
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Telephone | 312-337-7654
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Fax |
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Provider Business Mailing Address
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Address Line | 845 N MICHIGAN AVE #977W
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City | CHICAGO
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State | IL
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Zip | 60611-2252
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Country | US
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Telephone | 312-337-7654
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALAN HOWARD GOLDBERG
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Credential | M.D.
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Telephone | 312-337-7654
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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 | 036045750
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License Number State | IL
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