Provider Demographics
NPI:1699873778
Name:GOLIATH, JASON CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:CHRISTOPHER
Last Name:GOLIATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:396 REMINGTON BLVD
Mailing Address - Street 2:STE 240
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4302
Mailing Address - Country:US
Mailing Address - Phone:630-226-0664
Mailing Address - Fax:630-226-0669
Practice Address - Street 1:396 REMINGTON BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-4302
Practice Address - Country:US
Practice Address - Phone:630-226-0664
Practice Address - Fax:630-226-0669
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109882208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL75007522OtherBLUE CROSS NUMBER
IL75007522OtherBLUE CROSS NUMBER
ILK01398Medicare ID - Type Unspecified