Provider Demographics
NPI:1487654190
Name:BRUCE GOLDBERG MD S C
Entity Type:Organization
Organization Name:BRUCE GOLDBERG MD S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-480-0490
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4892660001Medicare NSC