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NPI Code Detail

MEDICARE: ELIZABETH CLARA GOODALL PA-C

MEDICARE: ELIZABETH CLARA GOODALL PA-C
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
1363AS0400XSurgical Physician Assistant085007020IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000000OTHERILOTHER

General Provider Information

NPI Number : 1780141481
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH CLARA GOODALL PA-C
Provider Business Mailing Address
First Line : 2650 RIDGE AVE STE 1223
Second Line :
City : EVANSTON
State : IL
Zip : 60201-1700
Country : US
Telephone Number : 847-570-2040
Fax Number : 847-733-5315
Provider Business Practice Location Address
First Line : 880 W CENTRAL RD STE 5000
Second Line :
City : ARLINGTON HEIGHTS
State : IL
Zip : 60005-2384
Country : US
Telephone Number : 847-618-3800
Fax Number : 847-618-3809
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2019
Last Update Date : 04/02/2026

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