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NPI Code Detail

MEDICARE: DR. DAVID A GOODMAN MD PHD

MEDICARE: DR. DAVID A GOODMAN MD PHD
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
1207Y00000XOtolaryngology PhysicianIL

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 : 1477610665
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID A GOODMAN MD PHD
Provider Business Mailing Address
First Line : 390 E CONGRESS PKWY
Second Line : UNIT M
City : CRYSTAL LAKE
State : IL
Zip : 60014-6202
Country : US
Telephone Number : 815-455-0858
Fax Number :
Provider Business Practice Location Address
First Line : 390 E CONGRESS PKWY
Second Line : UNIT M
City : CRYSTAL LAKE
State : IL
Zip : 60014-6202
Country : US
Telephone Number : 815-455-0858
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2007
Last Update Date : 07/08/2007

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Directions to “ DR. DAVID A GOODMAN MD PHD” Practice Location

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