Provider Demographics
NPI:1427353184
Name:RICHARD S. GOLDBERG, M.D., LTD.
Entity type:Organization
Organization Name:RICHARD S. GOLDBERG, M.D., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-814-6600
Mailing Address - Street 1:8311 ROOSEVELT RD
Mailing Address - Street 2:OPTIONAL
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-2529
Mailing Address - Country:US
Mailing Address - Phone:708-814-6600
Mailing Address - Fax:630-920-9095
Practice Address - Street 1:8311 ROOSEVELT RD
Practice Address - Street 2:OPTIONAL
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-2529
Practice Address - Country:US
Practice Address - Phone:708-814-6600
Practice Address - Fax:630-920-9095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360568682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036056868Medicaid
IL663460Medicare PIN
IL036056868Medicaid