Provider Demographics
NPI:1487674883
Name:GOLDBERG, SALMON S (MD)
Entity Type:Individual
Prefix:
First Name:SALMON
Middle Name:S
Last Name:GOLDBERG
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 1:10 BANNOCKBURN CT
Mailing Address - Street 2:
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1818
Mailing Address - Country:US
Mailing Address - Phone:847-444-0405
Mailing Address - Fax:847-444-0407
Practice Address - Street 1:500 SKOKIE BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2856
Practice Address - Country:US
Practice Address - Phone:847-272-4296
Practice Address - Fax:847-272-4177
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL269800Medicare ID - Type UnspecifiedBOURBONNAIS OFFICE
IL210645Medicare ID - Type UnspecifiedBUFFALO GROVE OFFICE
ILC44259Medicare UPIN
IL900770Medicare ID - Type UnspecifiedNORTHBROOK OFFICE
IL785030Medicare ID - Type UnspecifiedCRYSTAL LAKE OFFICE