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NPI Code Detail

MEDICARE: BRUCE J GOLDBERG M.D.

MEDICARE:   BRUCE J GOLDBERG  M.D.
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
1207X00000XOrthopaedic Surgery Physician036-072948IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417957226
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRUCE J GOLDBERG M.D.
Provider Business Mailing Address
First Line : 1059 W SKYLARK DR
Second Line :
City : PALATINE
State : IL
Zip : 60067-7058
Country : US
Telephone Number : 630-480-0490
Fax Number : 630-580-9641
Provider Business Practice Location Address
First Line : 1555 BARRINGTON RD
Second Line : STE 205
City : HOFFMAN ESTATES
State : IL
Zip : 60169-1063
Country : US
Telephone Number : 630-480-0490
Fax Number : 630-580-9641
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2005
Last Update Date : 01/25/2017

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