Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | IL |
NPI | 1497826440 |
---|---|
Provider Name | Lawrence Goldberg |
First Address | Evanston, IL 60202-1237 |
Second Address | Evanston, IL 60202-1237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 20/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C45433 | (02) | IL |