Provider Demographics
NPI:1184832487
Name:GOLDBERG, ALLEN I (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:I
Last Name:GOLDBERG
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 1:1018 W DIVERSEY PKWY
Mailing Address - Street 2:#2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1317
Mailing Address - Country:US
Mailing Address - Phone:773-248-8025
Mailing Address - Fax:773-883-1018
Practice Address - Street 1:1018 W DIVERSEY PKWY
Practice Address - Street 2:#2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1317
Practice Address - Country:US
Practice Address - Phone:773-248-8025
Practice Address - Fax:773-883-1018
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-057657208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics