Provider Demographics
NPI:1528068202
Name:GOLDBERG, JULIE S (MD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:S
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 WAUKEGAN RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1252
Mailing Address - Country:US
Mailing Address - Phone:847-205-0007
Mailing Address - Fax:847-205-0099
Practice Address - Street 1:513 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1252
Practice Address - Country:US
Practice Address - Phone:847-205-0007
Practice Address - Fax:847-205-0099
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-10
Provider Licenses
StateLicense IDTaxonomies
IL036097576207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H02805Medicare UPIN
209290Medicare ID - Type Unspecified