Provider Demographics
NPI:1346289980
Name:GOLDIN MERTDOGAN, RIFKI J (MD)
Entity Type:Individual
Prefix:DR
First Name:RIFKI
Middle Name:J
Last Name:GOLDIN MERTDOGAN
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:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:1401 LAKEWOOD DR
Practice Address - Street 2:SUTIE A
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-3352
Practice Address - Country:US
Practice Address - Phone:815-942-6323
Practice Address - Fax:815-942-6423
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360892172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL88550Medicare PIN
ILF74874Medicare UPIN
IL394150Medicare PIN