Provider Demographics
NPI:1215037247
Name:GOLDSTICK, BRUCE J (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:J
Last Name:GOLDSTICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4709 GOLF RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1231
Mailing Address - Country:US
Mailing Address - Phone:847-674-4363
Mailing Address - Fax:847-674-4387
Practice Address - Street 1:4709 GOLF RD
Practice Address - Street 2:SUITE 107
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1231
Practice Address - Country:US
Practice Address - Phone:847-674-4363
Practice Address - Fax:847-674-4387
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036066963207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180027499OtherMEDICARE RETIRED RAILROAD
IL31602258OtherBLUE CROSS BLUE SHIELD
IL31602258OtherBLUE CROSS BLUE SHIELD
180027499OtherMEDICARE RETIRED RAILROAD