MEDICARE: DR. CELINE GOETZ MD

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
1	207R00000X	Internal Medicine Physician	036142897	IL
2	390200000X	Student in an Organized Health Care Education/Training Program
3	208M00000X	Hospitalist Physician	036142897	IL

General Provider Information

NPI Number	:	1255620282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CELINE GOETZ MD

Provider Business Mailing Address
First Line	:	1717 W CONGRESS PKWY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3809
Country	:	US
Telephone Number	:	312-942-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 W CONGRESS PKWY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3809
Country	:	US
Telephone Number	:	312-942-4200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2011
Last Update Date	:	05/24/2022

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