Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 036-077-566 | IL |
NPI | 1023054731 |
---|---|
Provider Name | Dr. William Richard Goodell |
First Address | Des Plaines, IL 60016-4539 |
Second Address | Park Ridge, IL 60068-1110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 17/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F22854 | (02) |