Provider Demographics
NPI:1477611242
Name:GOREN, SEYMOUR BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:SEYMOUR
Middle Name:BERNARD
Last Name:GOREN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:180 N STETSON AVE
Mailing Address - Street 2:SUITE 3175
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601
Mailing Address - Country:US
Mailing Address - Phone:312-332-2262
Mailing Address - Fax:312-819-1316
Practice Address - Street 1:180 N STETSON AVE
Practice Address - Street 2:SUITE 3175
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601
Practice Address - Country:US
Practice Address - Phone:312-332-2262
Practice Address - Fax:312-819-1316
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
IL3636034207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG0425630Medicare ID - Type Unspecified
D11478Medicare UPIN