MEDICARE: SCOTT R. GOODWIN 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
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	036-129556	IL

Other Identifiers

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

General Provider Information

NPI Number	:	1831310226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT R. GOODWIN M.D

Provider Business Mailing Address
First Line	:	3122 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3014
Country	:	US
Telephone Number	:	773-769-9200
Fax Number	:	773-506-6083

Provider Business Practice Location Address
First Line	:	3122 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3014
Country	:	US
Telephone Number	:	773-769-9200
Fax Number	:	773-506-6083

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	12/22/2023

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Directions to “ SCOTT R. GOODWIN M.D” Practice Location

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