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NPI Code Detail

MEDICARE: RICHARD M GOLDIN

MEDICARE: RICHARD M GOLDIN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker149 009159IL

General Provider Information

NPI Number : 1174823108
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD M GOLDIN
Provider Business Mailing Address
First Line : 867 N DEARBORN ST
Second Line :
City : CHICAGO
State : IL
Zip : 60610-3310
Country : US
Telephone Number : 651-213-4286
Fax Number :
Provider Business Practice Location Address
First Line : 867 N DEARBORN ST
Second Line :
City : CHICAGO
State : IL
Zip : 60610-3310
Country : US
Telephone Number : 651-213-4286
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2010
Last Update Date : 10/25/2010

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