Provider Demographics
NPI:1477720886
Name:GOLDEN, ANTHONY E (PA-C)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:E
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11921 S CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-2320
Mailing Address - Country:US
Mailing Address - Phone:708-579-4900
Mailing Address - Fax:
Practice Address - Street 1:11921 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803-2320
Practice Address - Country:US
Practice Address - Phone:708-579-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003163363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant