Provider Demographics
NPI:1154328805
Name:GOYAL, LALCHAND T (MD)
Entity Type:Individual
Prefix:DR
First Name:LALCHAND
Middle Name:T
Last Name:GOYAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DOCTORS PARK
Mailing Address - Street 2:
Mailing Address - City:GIBSON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60936-2009
Mailing Address - Country:US
Mailing Address - Phone:217-784-2384
Mailing Address - Fax:217-784-2360
Practice Address - Street 1:10 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:GIBSON CITY
Practice Address - State:IL
Practice Address - Zip Code:60936-2009
Practice Address - Country:US
Practice Address - Phone:217-784-2384
Practice Address - Fax:217-784-2360
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036610A207RC0000X
KY26239207RC0000X
IL036067197207RC0000X
PAMD444694207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000388818OtherBCBS
PAMD444694OtherLICENSE
IN100332740AMedicaid
IL036067197Medicaid
KY64262397Medicaid
KY0223314Medicare ID - Type Unspecified
IL036067197Medicaid
KY00151013Medicare PIN
KY64262397Medicaid
C48843Medicare UPIN
KY0935361Medicare PIN