Provider Demographics
NPI:1962497271
Name:GOLDBERG, MICHAL (MD)
Entity type:Individual
Prefix:
First Name:MICHAL
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHAL
Other - Middle Name:
Other - Last Name:RADZYNSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1460 N HALSTED ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642
Mailing Address - Country:US
Mailing Address - Phone:312-279-8900
Mailing Address - Fax:312-981-6312
Practice Address - Street 1:1460 N HALSTED ST
Practice Address - Street 2:SUITE 402
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642
Practice Address - Country:US
Practice Address - Phone:312-279-8900
Practice Address - Fax:312-981-6312
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108529208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics