Provider Demographics
NPI:1386617694
Name:GOYAL, SUBHASH (MD)
Entity type:Individual
Prefix:
First Name:SUBHASH
Middle Name:
Last Name:GOYAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:333 S STATE ST REVENUE
Mailing Address - Street 2:#200 CHICAGO DEPARTMENT OF PUBLIC HEALTH
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604
Mailing Address - Country:US
Mailing Address - Phone:312-747-9443
Mailing Address - Fax:312-747-9447
Practice Address - Street 1:333 S STATE ST REVENUE
Practice Address - Street 2:#200 CHICAGO DEPARTMENT OF PUBLIC HEALTH
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604
Practice Address - Country:US
Practice Address - Phone:312-747-9442
Practice Address - Fax:312-747-9447
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL231470Medicare ID - Type Unspecified
D15674Medicare UPIN