Provider Demographics
NPI:1083692719
Name:GOLDMAN, LAURIE B (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:B
Last Name:GOLDMAN
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 1:1655 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE 301-W
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-3982
Mailing Address - Country:US
Mailing Address - Phone:847-686-6666
Mailing Address - Fax:847-686-6666
Practice Address - Street 1:1655 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 301W
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3982
Practice Address - Country:US
Practice Address - Phone:847-686-6666
Practice Address - Fax:847-686-6666
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360853672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF46864Medicare UPIN
IL523460Medicare ID - Type Unspecified