Provider Demographics
NPI:1417957226
Name:GOLDBERG, BRUCE J (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:J
Last Name:GOLDBERG
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 1:1059 W SKYLARK DR
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-7058
Mailing Address - Country:US
Mailing Address - Phone:630-480-0490
Mailing Address - Fax:630-580-9641
Practice Address - Street 1:1555 BARRINGTON RD
Practice Address - Street 2:STE 205
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1063
Practice Address - Country:US
Practice Address - Phone:630-480-0490
Practice Address - Fax:630-580-9641
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-072948207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036072948Medicaid