Provider Demographics
NPI:1992887541
Name:GOLDEN, ROBERT S (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 E HURON ST #12-205
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3127
Mailing Address - Country:US
Mailing Address - Phone:312-944-0688
Mailing Address - Fax:312-944-2886
Practice Address - Street 1:201 E HURON ST #12-205
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3127
Practice Address - Country:US
Practice Address - Phone:312-944-0688
Practice Address - Fax:312-944-2886
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086290207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1172487OtherUNITED HEALTHCARE
IL0360862901Medicaid
IL4476901OtherAETNA
ILF75131Medicare UPIN
IL0360862901Medicaid