Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | IL |
NPI | 1134157480 |
---|---|
Provider Name | Stuart Lewis Goldman |
First Address | Park Ridge, IL 60068-1005 |
Second Address | Park Ridge, IL 60068-1005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D15948 | (02) | IL |